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TOWN OF YARMOUTH Building Departme (5398-2231 e ... PERMIT NO :BLD-15-000179 JJJJJJJI•JJJJJJJJJJJJJJJJ/lJ ISSUE DATE :07130/2014 - JJIJIJIllIIIJJJJJJJJl .............................. ....•..••.•.•..._••__ •_ __ APPLICANT :Barnstable County Sheriffs Dep+ ......................................................... BUILDING PERMIT JOB WEATHER CARD ........................ . PERMITTO New I AT (LOCATION) 1108 BRAY FARM RD NORTH, YARMOUTH, MA 0 1 ZONING DISTRICT I ( Bldg. Type:. lCommeraal . . 11 SUBDIVISION MAP BLOCK LOT 1151.24.1 BUILDING IS TO BE: CONST TYPE USE GROUP REMARKS Construct 40' X 40' Temporary Tent for TOGETHER WE GROW (15th Anniversary Picnic) from 7/31/14 - 812114 Per 780 CMR MSBC and Town of Yarmouth Zoning By -Laws AREA (SQ FT) 909,968.40 EST COST($) 0.00 PERMIT FEE ($) 0.00 OWNER TOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146ROUTE28 CONTRACTOR LICENSE SOUTH YARMOUTH IMA 102664-44631 PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC . SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL — - FINAL INSPECTION HAS BEEN MADE. _._ . _ __ _ , REQUIRED FOR ELECTRICAL MEMBERS (READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBINGIGAS AND COVERING) 3) FINAL INSPECTION BEFORE REQUIRED, SUCH BUILDING SHALL NOT BE . MECHANICAL INSTALLATIONS. OCCUPANCY 4) REFER TO DETAILED INSPECTION OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET - BUILDING INSPECTIONS APPROVALS WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF ' INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION: STAGES OF CONSTRUCTION ILI^r M.n^%. TOWN OF YARMOUTH Building Department BUILDING (508) 398.2231 ext.1261 ............................ PERMIT PERMIT NO :BLD-15-000750 :rrrxrxx: r�xr x :rr ISSUE DATE :0812612014 JOB WEATHERCAR irrrxrrr......... i rra i. .___' ... ... ..._ .. - .... D APPLICANT ;Plymouth Taylor Rental PERMIT TO New AT (LOCATION) L108 BRAY FARM RD NORTH, YARMOUTH, MA 0 I ZONING DISTRICT Bldg. Type: IResidential i SUBDIVISION MAP BLOCK LOT 115124.1 BUILDING IS TO BE: CONST TYPE L__j USE GROUP REMARKS erect temporary tent- wedding 9/5/14 - 917114 AREA (SQ FT) 909,988.40 EST COSTS) 100.00 PERMIT FEE ($) OWNER TOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146ROUTE28 CONTRACTOR•' LICENSE ti SOUTH YARMOUTH IMA 02664.4463 PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY: THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY.* BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OFANYAPPLICABLE SUBDIVISION RESTRICTIONS.. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL MEMBERS (READY FOR LATH OR FINISH _ - WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND COVERING) 3) FINAL INSPECTION BEFORE REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPANCY 4) REFER TO DETAILED INSPECTION OCCUPIED UNTIL FINAL INSPECTION HAS SCHEDULE BEEN MADE. _ POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS - I u I Hilt: WORK SHALL NOT PROCEED INDICATED ON THIS CARD PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION.. - STAGES OF CONSTRUCTION NOTED ABOVE. TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext1261 ........................... PERMIT PERMIT NO :BLD-15-000636 ISSUE DATE t08/2012014014 " JOB WEATHER CARD APPLICANT ;BARN/CO.SHERIFFS/508-563 PERMTTTO : New ...................................... ........... AT (LOCATION) 1108 BRAY FARM RD NORTH, YARMOUTH, MA 0 ZONING DISTRICT [t±O_j Bldg. Type: t'� SUBDIVISION MAP BLOCK LOT 1151.24.1 BUILDING IS TO BE: CONST TYPE USE GROUP REMARKS Temporary Tent 20' X 40' from Aug. 22 thru Aug. 25 as per 780 CMR MSBC and Town of Yarmouth Zoning Bylaws AREA (SQ FT) 909,968.40 EST COST($) 0.00 PERMIT FEE ($) 35.00 CG➢ITn14-� ]I ►I�L� . 0 Nisl BUILDING DEPT BY ADDRESS 11146ROUTE28 CONTRACTOR LICENSE SOUTH YARMOUTH I IMA 02664-4463 1 PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM . THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION W0RK:.1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE.. -- WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS APPLICABLE TE PERMITS ARE ED FOR ELECTRICAL VG/GAS AND 41CAL INSTALLATIONS. WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION NOTED ABOVE. h or * TOWN OFYARMOUTH BildingDepartment``' _ BUILDING _ _ _ '_ _ _ _ - _ (508) 398-2231 ext.1261 s PERMIT NO _-----1402_- PERMIT ISSUE DATE ;_ 412212014 , ; PROPOSED USE _ ....... _ . APPLICANT William Pianinshek " " " " " " " " JOB WEATHER CARD PERMIT TO ;' Misctrisutation AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bidg. Type: Commerdal SUBDIVISION MAP LOT BLOCK 151.24.1 LOT SIZE . F Install Insulafton In existing structure - only REMARKS BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R.3 CONTRACTOR LICENSE 905981 Planinshek, William 15 Lexington Lane AREA (SQ FT) EST COST ($ $3,200.00 PERMIT FEE ($) $0.00 Yarmouth Port MA 02675 0 5082481478 OWNER rOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146Route28 South Yarmouth I MA 102664 1 PHONE 5083982231 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBWC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.: WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBINGGAS AND MEMBERS (READY FOR LATH OR FINISH REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. COVERING) 3) FINAL INSPECTION BEFORE OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4) REFER TO DETAILED INSPECTION BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET r:1»:r•I7:1�9 K � ,� jy��� ,'� K� �"� • ; � V. 2 F�„iy3-� Ps-(i 0Ij Gam? vt- 5�- 3 '' / ��� ��- 4 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STANTED ITHI F ARRANGED FOR BYTELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT ION. IS ISS, STAGES OF CONSTRUCTION 1AA( O H RECEIVED VEED AUG 26 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 umce the tmty Permit -/S— Fee S S issue ski expires 6 months from CONSTRUCTION ADDRESS: /O$ 4R,4 � Fi9km R D . A/l74ye co ASSESSOR'S INFOWMATION: OWNER: Map: /5 Parcel: AV. NM1E I PRESENT ADDRESS CONTRACTOR: P'-Vfm iw ` ?i yc oe elf/_ /3 GAinczor- he re89, ) 5c ,9 - NAh1E MAH1140 TEL A `y VM, /z1A/d23&O , Residential Commercial �O Est. Cost of Construction S Ilome Improvement Contractor Lie. R Construction Supervisor Lk. # Workman's Compensation Ins ranee: (check one) I am the homeowner i I am the sole proprietor 1 have Worker's Compensation Insurance Insurance Company Name.• Worker's Comp. Policy# /�y���nc WORK TO BE PERFORMED Tent(FunRetatdantCatlBcareanachedj""'" S J u, t ❑ Wood Stove Shed O Siding: # of Squares C Replxement windows: - ❑ Replacur ent doter. # O Re-mof: #orSqua es ❑ Insulation () Stripping old shlrmgks• () Icing overlayer of existing roof ❑ Old Kings Hlghway/Htttodc District Roofing/Siding (like for Like) *The dclxts win be disposed of at: Tiq,L'ElC% L✓ �T}/ (�$ t.ocation of Facility I declare under penalties of perjury that the statements herein contained are the and correct to the lest of my knowledge and henet. I understand that any false answer(s) win be just cause for denial or revocation of my license and for pmsecndon under MO.L CT. 269. Section 1. Applicant's Signaun/. &e. z 1 iQC/1 Date: g I Owners Signature (or attachment) D■te• Approved By: i Date: Building official (or designee) Zoning District -- Historical District Yes No Flood Plain Zones Yes No Water Resource Protection District Within 100 ft. of Wedands: Yes No Yes No 3101 i 05/22/2614 13:13 812-867-0547 ANCHOR IND PAGE 01/02 IMPORTANT DOCUMENT Certificate of Flame P�fsistance ISSUED BY Dote of Shipment 529/14 Registration Number F140.01 INDUSTRIES INC. Sales Order It 16C45044 EVANSVILLE,INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This Is to certify that the materials described are inherently flame retardant and were supplied to: 781521 r — ARTUCK INC: i TAYLOR RENTAL CENTER 114 LONG POND RD. PLYMOUTH, MA 02360 i Certification is hereby made that: The articles described on this Certificate have been treated With a flame-retardant approved chemical and that the application of said 'Chemical %vas done in conformance with California Fire. Marshall Code. All fabric has been tested and passes NFPA 701-04, ULC 109. Serial 0 8100975 (2) Description of item certified: CENTURY MATE EXPANDABLE MIDDLE 40M20 SNYDER BLOCKOUT WHITE VINYL I i Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric I jCy 9NYDER, NEW PHILADELPLIIA, OH Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC i i I . i i i rn...•ex. ea�aee DI VUnTAV ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MNIDWYYY) 710=014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER USI Rental Specialties 1616 Smith Road, Suite D Temperance, MI 48182-TX 888 489-7165 TACT NAME: PHONAX E AM Hu Ex : 686 489-7165 A/C No): 888 489.7105 ADDRESS: i E-MAIL INSURER(S) AFFORDING COVERAGE NAIL/ ! I INSURER A. Hartford Fire Insurance Company 19682 INSURED I f INSURERS: Hartford Casualty Insurance Corn Plymouth Taylor Equipment Rental, Inc I INSURER C: 29424 dba PTR Equipment & Sales 13 Camelot Dr I INSURER 0: INSURER E: Plymouth, MA 02360-2643 IINSURER F: - COVFRARFS rPPTIFIrATF NIIMRFR• REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR �ADDLSUBR TYPE OF INSURANCE IN581 POUCYNUMBER POLICY EFF M/D POLICY EX M/ M1DDYP LIMITS A GENERALLIABILITY ! 45UUNQY9497 0113112014 01/31/2015 EACH OCCURRENCE $1 DOO OOO BREMISES E%Iccu ants S3OO OOO X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE COCCUR j MED EXP (Any anePerson) Si0000 PERSONAL S ADV INJURY $1 000 000 1 GENERAL AGGREGATE S2,000 O00 GENT.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG s2,000000 S X I POLICY PRO• LC-- B AUTOMOBRELIABILITY 45UENCIY9905 D113112014 01/31/201 BOMB IN aDtSIN LE LIMIT1,000,000 BODILY INJURY (Par Person) 5 X ANY AUTO BODILY INJURY (Par aod0enl) S ALL OWNED SCHEDULEAUTOS ) AUTOS NOv-OWNED HIRED AUTOS AUTOS I PROPERTY DAMAGE Par smdenl $ s I B X UMBRELLA LIAS X IOCCUR 45HHUQY9371 1/31/2014 0113112015EACHOCCURRENCE 51000000 AGGREGATE 311,000.000 EXCESS LIAR i CLAIMS -MADE DED I X1 RETENTION S10000 i S A WORKERS COMPENSATION i AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNER'EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? a (Mandatory In NH) NIA 45WEQY9911 1/01/2014 0110112011 X WCSTATU. oTH- E.L. EACH ACCIDENT E.L. DISEASE • EA EMPLOYEE S1 ODO OOD $1 000000 31,000,000 M yea desnnbe under - DESCRIPTION OF OPERATIONS below I _ E.L DISEASE • POLICY LIMIT A Inland Marine 45UUNQY9497 1131/2014 01/311201 Limit: $1,600,000 Equipment Floater Deduct: $1,000 DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, N mom span is required) This certificate holder is listed as additional insured with regards to liability arising out of operations performed by named insured as their interest may appear. EVENT DATE: 914114 to 919/14 EVENT LOCATION: Taylor Bray Farm,108 Bray Farm North, Yarmouth Port, MA 02675. . I Leda Hennessey 9 Barn Board Lane West Yarmouth, MAC 02673 I I I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) 1 of 1 #S1286988TIM1162TS25 1 - ® 1933-2010 ACUKU UUKYUKAI IUN. AU ngnis reserved. The ACORD name and logo are registered marks of ACORD LXSAH PTR Equipment Contrail DBA: NorthEast Party Rentals Workmanship, Permits, & Location Damage All items rented are guaranteed to be as specified and as warranted by the manufacturer. Every town has a permit process for setting up a tent. It is your responsibility to obtain the permit, unless requested otherwise. Most towns require a flame resistant certificate for the tent, and a certificate of insurance, which we can provide you with. The materials and work will comply with'applicable building codes and ordinances. It is the responsibility of the Client to contact DIGSAFE (800-DIG-SAFE) to have all underground utilities marked. The Contractor is not responsible for damage to landscape structures, including but not limited to underground irrigation systems, sewage systems, electrical wiring and communication systems. Delivery & Set-up: Northeast Party Rentals will make every effort to accommodate Clients delivery requests; however delays and changes in the schedule are sometimes unavoidable. We will touch base with you the week of the event to set the delivery time frame for the day of. The tent and lights will be properly set-up and secured by the NE Party crew. Tables and chairs will be placed under the tent. Set-up of tables and chairs is available at an additional fee and must be discussed prior to delivery. Customer shall inform NE Party of any significant distances (approximately 100ft) between where our truck can park and location of the set-up on the property. Additional fees may apply for significant distances. Changes: Changes such as number or tables and chairs can be made up to the time of delivery, but will be based on availability. Major changes, including without limitations, size of the tent rented, must be address as soon as possible and will be based on availability. There may be additional fees involved. Final counts on linens must be made a week prior to the event. Weather: Tents are temporary structures designed to handle most normal weather conditions. However, there may be situations that arise when it is unsafe to set-up the tent, such as high winds or lightning. NE Party will work with client to come up with alternate options, but ultimately, we reserve the right to refuse set-up or take down the tent early, due to these extreme conditions. If these situations arise during the event, you must evacuate tent and call the NE Party. No refund will be given if cancelation occurs due to extreme weather conditions. Charges and Payments: A 50% non-refundable deposit is due at the time the reservation is placed. The balance is due the day before delivery. If the Client is paying with a check, the balance is due 1 week prior to the event. We require a credit card even if the Client is paying with cash or check. The credit card will be used for any damaged, lost or missing items, in addition to last minute changes which result in additional charges. The Client agrees to pay all costs of collection, including attorney fees, court fees and other expenses incurred if the terms of this agreement are not met. Clean Up & Preparation for Pick Up: Prior to delivery, customer must clear yard of any obstacles where the tent will be going, including dog feces. Irrigation must be turned off while tent is erected. All trash and decorations must be removed from the tent and other rental equipment before scheduled pick up. All chairs and tables should be stacked in designated location when delivered. Linens should be shaken free and placed in the laundry bags. Serving ware, including but not limited to china, glassware, silverware, and chaffing dishes, must be rinsed free of any food. - Additional charges may apply if these conditions are not met. The parties have read the contract and reservation. They have received copies of and agree with the requirements on both. 12 Client(Signature) '7(5 11 (Date) FtED�14 Permit expires ISO days from issue date TMENT UILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 o�67S (508) 398-2231 Ext. 1261 >49 M CONSTRUCTION ADDRESS: - l /t �/[re— 8 RA (/ ert}+t°iy_ /08 ;3f{'4f/ FOA1 ASSESSOR'S INFORMATION: /� Map: /!� Parcel: � OWNER: bg al �/ Fii e m NAME I PRESENT ADDRESS Tl - # Email Address: CONrRACroR: B "N 57#BLE (204 NTf/ S/{EICI FF 508 - 5-6 3 •430s NAME MAUJNG ADDRESS TEL # Email Address: Residential . Commercial Est. Cost of Construction $ Home Improvement Contractor Lin # Construction Supervisor Lic. # Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. 10 aa, 07 /L WORK TO BE PERFORMED Tent Duration Siding: # of Squares (Fire Retardant Certificate attached?) Replacement windows: # Roofing: # of Squares ( ) Remove existing* (max. 2 layers) Old Kings Highway/Historic Dist. ( ) Replacing like for like Me debris will be disposed of at: Location of Facility Wood Stove Replacement doors: # Insulation I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocatig o§my license and for prosecution under NLCL Ch. 268, Section 1. Applicant's Signature:, Owners Signature (or Approved By Date: Building Official (or designee) RECEIVED AMA1I BUILDING P RTMENT By: �Distrir Historical Distri `/ No Water Resource Protection District: Yes No J Flood Plain Zone: 7Kes Within 100 fL of wetlands: Yes No No The Commonwealth of Massachusetts Department oflndustrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 021.11 www.mass:gov/dig Workers' Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers Name (Business/Orgmization/Individvai): 77/4-yz/kS 7e-Lr a/'oYa✓7---, City/State/Zi : 126JKr✓'ce— Phone#. 56 T 30-j Are yga in employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time). have hired the sub -contractors . 6• ❑ New coastuction 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp, insurance require&I 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance I t 3a ❑ I am a homeowner acting as a general contractor (refer to #4) listed on the attached sheet. These sub -contactors have employees and have workers' comp, insurance.: 5. ❑ We are a corporation and its officers have exercised their . right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' , comp. insurance retmire l- 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 I.❑ Plumbing repairs or additions 12.❑ Roof repairs .13.0 Other 'Any aPPliOnt that eheela box #1 tt@st also fill ore the section below l t homeowners who submit this affidavit indicating thry are doing all wade and dreg him outside iafo�aIIon tComtactms that ehwk this box mast attached an additional sheet showingthe name of the ` im matst submit a Or affidavit indicating such employees. If the sub-wnIIact= have I on er and state wheth¢ or not thox .catities bave emp ogees. they mast provide their workers, romp- Percy camber: I am an employer that is providing workers' compensation tasurance for arty employee& Below is the policyatnd job site information. Instuance Company Name: Policy # or Self -his. Lic. # Expiration Date Job Site Address: City/Statemp: Attach a copy of the workers' compensation policy declaratlon page (showing the policy number and expiration date). Failure to segue coverage as required under Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to S I,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Y 8 - 7•p - 680 -17/49 Of ji'cial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #- Information and Instructions to werkers' compeaaation far their emp{oY�- M r3ulm: o tts General Lawn chapterymis defined as "•_evay, pesos is � smite of another under any contact of hire,` pursuant to this shtutc, m tarpLy[t egress cc implied, oral or written." association, corporatiaa cc other legal entity, or my two a more An satplgsr is defined >� m individual, iseaInc, of a deceased employer, a the of the famping engaged in a�omt ', tandd err k �f� byes, However doreceiver or trustee of an mart idnal, patoersh*6 ssaocration a other Iep1 entity, employing CmP owner of a dwelling boom having not mote than•three apartments and who resides therein. cc the occupant of the person to do ".rye, const action or repair work on such dwelling bonsa dwelling boos of another who employs or on the ground: or building there shall not because of such eapfoymeai be deemed to be in�" ampb MGL chapter 152,125C(6) also states tbst "enr7 state or local Beensing agesey AaII withhold the fssstanet or renewal *(a lleeme or pamft to operate a bustamsa or to tantrum! bWkUnp 1s the eomm m"Ilth for aq applicant lute has not Fvd=d terePtsbb mvtdence of compliance with the War"" cavwage reqWreL" Additicridy. MGL char 152, J25C('7) stater "Neither the commonwealth nor any of its Poh&d subdivision sha11 enter into any coated fat; the pcdmmaaca of Public work tmti7 acceptable evidence of compluace with the insamce requfrzmeata of thu clsspter bave been presented to the ==Ratting =dwity-" Applicant . Pleases fill out the wvd=g compeassdm affidavit completely, by �g the bo%ft that apply to your sintatinn and, if necessary. supply sub-�r(s) nsme(s)* sdd c*es) and phow number(s) along wtheir cerb wztb no aapbyees other rinser the insmraaca Limited frabrft Compsaier (LLL7 cc Limited Liability Partmaahips (i.LPi . members or pparmas, are not required to carry work=, compematiou, ftw=nce. If an LLC a LLP does have empkD=M a Policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmadon of i0suranott cover:gAtw be :ogre to sip and data the aflMavt Tb s� be ret coned to the city or town that the appiicadoa for the Permit or licanss is being requested. Department of Industrial Aecidents. Should you have any questfona rep:diag the law Q if yoa:m regoaed to obtain a warias' compeassbon Policy, Please call the Department at the number listed below. SelUnsu ed companies should eater theft Clty or To" Of moie Please be sire that the affidavit is complete and printed legibly. The Department his provided a space at the bottom of the affidavit for you to fill out in the event the office of Investiptfons has to contact you mgarding the zppliczm Pinn be sae to fin in the Permitlifeease I which will be used as a refereaee TrM r J r In addidm anapplicant that out submit multiple p applications in any gives yet, need only subs one affidavit indicating cnm:ent P )licy ftdMMzd= (ff necenary) and under "lob Site Address" the applicant should write "an loczd= in (city or town)." A copy of the affidavit that has bees ofBcfaiiy st, I I oe ma isd by the city or tower may be provided to the applicant as proof drat a valid affidavit is an Me for future pamita or licenser. A new affidavit must be Med out each Yea- Where a home owner or citizen is obtaining a license at Pam not rehrted to any buriaas or commacisl v=MM (Le. a dog Ucem or permit to bum lewres cte.) said person is NOT regoaed to complete this affidavit The Of2fcm of Investigation would lace to thank you in advancer for your coopastion and should you have any question. please do not hesitate to give us a all. Ilse Dcpartmeat's address, telephone and fax mamba: Tie Commonwealth of Massachusetts Department of Industrial Accidents Offlet of Imestiptlons 600 Washington Street Boston, MA 021 I1 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax 9 617-727-7749 Revised 11-224g6 wwyanass•gov/dia REMINI M PO RTANT DOC 'IVI E NT tifi Cercat�e of Flame Resistapce REGISTRATION APPLICATION NUMBER F121.4 ISSUED BY s WTFU r EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN Date of Shipment 3116/2007 Tent Identification This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: '76980 BARNSTABLE COUNTY CORRECTIONAL 6000 SHERIFFS PLACE BOURNE MA 02532 04459337 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. Serial # RW2100 (1) Description of item certified: FIESTA TOP 20WX40 WHITE VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric /� JOHN HOYLE STATESVILLE NC Signed: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. r TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 PERMIT NO �_6-13-1766PERMIT ISSUE DATE : _ _ 6/fi12013" _ : PROPOSE s _ ; M APPLICANT bundercover Teri s Party " " " " " " " " " " JOB WEATHER CARD . ---- PERMITTO MiscJTent AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT Bldg. Type: lCommercial SUBDIVISION MAP LOT BLOCK LOT SIZE E BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 Temporary Tent —for Two 20' X 4V Tents and One 40' X 40' tent from Barnstable County Sheriffs Dept. REMARKS AREA (SQ FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER OWN OF YARMOUTH - BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH YARMOUTHPORT MA 102675 INSPECTION RECORD Date Note Progress - Corrections and Remarks CONTRACTOR LICENSE 0 r � PHONE 15083982231 FIELD COPY Inspector 9F-TOWN OF YARMOUTH PERMIT NO Building Department ILDING _ _6-13-1767_ _ _ _ _ _ _ _ , (508) 398-2231 ext.1261 BU _____.._ ^ ISSUE DATE :_ _61612013PROPOSED USE PERMIT _ _ ; APPLICANT -Barnstable county SherillsDept JOB WEATHER CARD AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DIS SUBDMSION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: LOT SIZE E Temporary Tent — One Fiesta Top 20' X 40' White Vinyl wBam Logo REMARKS PERMIT TO ks'r-- Tent rRl Bldg. Type: Commercial CONSTTYPE 5-B USEGROUP R-3 AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) 30.00 OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH ' AR OUTHPORT I MA 102675 INSPECTION RECORD Date Note Progress - Corrections and Remarks t PHONE CONTRACTOR LICENSE 0 FIELD COPY EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOU M Foy 1.*A qnntxJ 5f>aef Frs4. Yarmouth Building Department as� �teriaT •eIYK 1146 Route 28 _ South Yarmouth, MA 02664 LTv l /4 t (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS:1o8 QcI I ao4 Rd •0 N. , G,Q.nue5A /ar� ASSESSOR'S INFORMATION: Map: IS Portal: a OWNER: NAME PRESENT ADDRESS TEL # u[rtee un umry tannic r Fee $ 3s Permit expires 6 months from issue tkue. NAME jMAIIliVt1 ADDRESS TEL • Residential Commercial ❑ Est. Cost of Construction $ Home Improvement Contractor Lie. I Construction Supervisor Lie. i Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor 1 have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy#, % , O )C -4 o WORK TO BE PERFORMED t➢ Tent (Fine Retardant Certificate attached) 0 Wood Stove Shod C Siding: R of Squares C RepLxemst windows: 9 C Replacementdoors: • O Re -roof. I of Squares O () Stripping old shingles* ( ) going over layers of existing roof '7he debris will be disposed of at: 348-4000 —/ ECEIVED W Gld King, lighwayfflistoric DDiispula _ Roofin g (0 14 I declare under penalties of perjury that the sta[emems herein contained are true and coral to the best of my knowledge and belief. f understand that any false answer(s) Will be just cause for denial revocation of my)iccnMw and for prosecution under MG.L Ch. 268. Section 1. C Applicant's Signatur Darr leis/ (Z� ZD l� Sv$-385•i9� Owners Signature (err ehmmll Mir Approved By Dmr. Building Official (or designee) PECEIVFD gy 14 2014 B' IL6FjIJ;A*RTMENT zonln; DWr{ct: Mtodcal District: Yes No Flood Plain Zonr. Yes No Water Resource Protection District: Within 100 R. of Wetlands: Yes No Yes No . Client8: 436885 UNDERTEN ACORD. CERTIFICATE OF LIABILITY INSURANCE. °"1t"°"' 5/131201414 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: N the certificate holder is an AAbDmONAL INSURED, the poliey(ies) must be endorse . If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. Certain po8e193 may require m endorssmonL A statement on this certificate does not confer rights to tho certificate holder in lieu of such endorsement(s). PRODUCER _ r t. NAMEI USI Rental Specialties PMONE P.O. Box $3310 IQ, m E" : 800 854-0298 car R,r Irvine, CA 92619 cDON�s" 800 854.i298 INP OR SI�PFDINCCGVERAGE Rue■ _ INSURER A, St Paul Fire A Marine Insurance _ 24767_ mum INsrmER a I Travelers Indemnity Co of CT 25682 Undercover Tent dr Party, Inc. 31 American Way rrsuaER c1etsuRERo South Dennis, MA 02660 -- INSURER E i MSURERFI •• COVF171RCS weernv. a� ununvn. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD -INDICATED. NOTWITHETANDINC ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONOMONS OF SUCH POLICIES. LDAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS - IN.It A 0 1ki au PouerE� PpL�Oy EXP • . T ME OF INSURANCE WQ POLICY NUMBER pOl•I MIOD/1,n "UPS A rEmERI uAlOUTY. ZPPlSR357891347 111211201311121201 EACHOCCURRENCE$1000000 X COMMERCIALOENERALwdLITY CIaM:.MADE nX OCCUR GIiE^+- N1Kq`Oywnt el 3100OOo MEO EXP siw �) $5 000 PEIUOFIAI a AOV WJURY i1 OOO OOO 32,000,00 GENERALADOREOATE - GENt AOOREGATE LIMIT APPLIES PER: X POLICY PRO- lErrLoc PROOVCTS.COIAPIO ►G0 1000,000 $ AUTOMOeLILIABLRY COMBINEO SINGLr LIMIT mAxwdomi 3 ANYAUTO ALLOWNED SCrEOULED AUros AUTOS MRED AUTOS AUTO - .. .. 000LreAAIRr IPoprson) BOOLYeLaRY t PROr� 3 ••• 3 UmamLA LIAR axetssLIAO oeella CLAIMS4AAOE EACH OCCvaREHCE s �. Ax.RECATc s Df0 I R N N 3 - 8 WORKERS COM"ENSATiON AND sMPLoRs uwaIUTY qWill OFFISRMBEqR DCUTNMNMM Me dIF NH) E Frss�.o wea vrlder 8. O oEBCRIPnON OF OPERAiIOtvS PWn. XEUB1999T91213 1112112013 11211201 w_e srAru ar El EACH ACCINM $1 OOO OOO ELdS-ASE.EAENPLOYEt $1000000 E.Ld •-POLICY LIMIT $1000000 $600,000 Limit 51,000 Deductible A Equipment Floater Special Form _ _ ZIMISR482141347 1112112013 1112112014 OESCRIPTION OF OPERATIONS I LOCATIONS 1 KNCTJIa JAM" ACORD 131. A"dwemd RAiPwRt St11MrAA N 0" pM h 111"11,04) This certificate Is Issued as a matter of proof only. Taylor Bray Farm 103 Bray Farm Road Yarmouth Port. MA 02875.0000 SFWULO ANY OF THE ABOVE OESCMGEO POLICIES BE CANCELLED BEFORE TNO EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE BRTN THE ►OOLCY PROVISIONS. AVTHORKEO REPRESENTATrA .. 5.o 4v Iv AUUKU GLIHHOHATION. An rights reserved. ACORD 23 (2010185) 1 of 1 The ACORO name and logo Oro registerod marks of ACORD 93124727131M71482462 AXLJG Ttrtfflk tt of iflame fiestatunce REGISTERED q ISSUED 8Y ANCHOR INDUSTRIES INC. Du•dManutacWra APPLICATION j 3104196 r NUMBER EVANSNLLE IN0IANA47711 1. j Ord•r Number MANUFACTURERSOFTHE FINISHED F 121.4 TENT PRODUCTS DESCRIBED HEREIN 1118531 This Is to certify that the materials described have been flame-retardant treated (or are Inherently noninflammable) and were supplied to: UNDERCOVER TENTS 80 MID TECH DR UNIT 3 WEST YARMOUTH MA 02673 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done In conformance with California Fire Marshall Code, equal to.or exceeds NFPA 701, CPAI 841 ULC 109 The method of the FR chemical application is: f sartal t•: 8040000C (0001) } 0escription of itam Certified: I p�Q ��yy ��yy ��33Pp©©�� rr TO MADE Yb AI..ADEMY SPECS FOR ACADEMY FRAMES �1Flame Retardant Process Used Will Not- • -• Washing By And Is Effective For The Life Of The Fabric �-I( 414ame of Appiicator at Flame Resistant Finish �_ • - INDUSTRIES INU. W0 7 i 7rT� � % s«e �i � � l •.�(Ti: F*�. « « ��4r? f �� •1J }` I EXPRESS BUILDING PERMIT APPLICA TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 'Permit # 1/7 c 'Fee S Permit expire 6 mnnrhs from ? issue date. CC.1 T1ED AUG-2 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: / Map: Parcel: ��f• / ' / OWNER: -lit % LOii Ble4 5I "4"'1Fk Al /OS 81?&W 6 D /VOPTi� NAME PRFSENTADDRESS TEL # .-*CONTRACTOR.- 6"//ST?9 P 4E �oauT f/ ShS�Ri �F 5fi"Ircors PLI-eE, _. NAME MAILING ADDRESS TEL # ❑ Residential ❑ Commercial ❑ Est Cost of Construction S O Home Improvement Contractor Lie: # Construction Supervisor Lie. # Worl maws Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# /A/ S'IVU� 6 - 3 -13 WORK TO BE PERFORMED Teat (Fie Rr=dant CatiEcate amcheQ ❑ Wood Stove Shed ❑ Siding: # ofSgvares Patuoys_: 8 -1-6 �0 (r; � QiEIE ?D Replacaaentwindows-4 ❑ Replacement doom. # /o/ C/() /(rj ❑ Re-rooE # of Sgaares ❑ Insulation () Stripping old shingles' () going ova sayers of existing mof ❑ Old Kings Highway/ILstoric District RooSng/Siding (Like for Like) ''Ibe debris will be disposed of at: Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any filse answer(s) will be just cause for denial or revocation license and for prosecution under M.QL Ch. 268, Section 1. Applicant'sSigoanna Date Owners Signature (or attachment) Date: Approved BY: Date:Building Official (or designee) 0 Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 & of Wetlands: ❑ Yes ❑ No . 0 Yes . ❑ • No ` The Commonwealth ofMassaehusetts Department of industrial Accidents Of ere of investigadons 600 Washington street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Auoectricians/plumbers l]cant Information Please Print Legibly Name(Bucmess/Organiz mdodiadividual):..a_ Address: R R 'AI STI R r e nu Al y Ci /State/Zi : IFs•' Pf,&dF Phone #: & Ri1lE M O a-53 7- Are you as employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Type Of ProJ� (required): employees (fir11 and/or part-time).' 2. I am a sole proprietor have hired the sub -contractors listed 6• ❑ New construction or partner: ship and have no employees on the attached sheet. These sub contntcton have 7. ❑ Remodeling . . working for me in any capacity. employees and have worker' 8' Demolition [No workers' comp. insurance comp. iasurance.t 9. 0 Building addition required:] 3. I am a homeowner doing all work 5. p we are a corporation and its officers have exercised their 10.0 Electrical repairs or additions myself. [No workers' comp. right of exemption per MGL 11. Plumbing g repairs or additions 3a ❑insurance required] t I ram a homeowner acting as a C. 152, § 1(4)• and we have no 12.❑ oof repairs Benerel contractor (refer to tY4) employees. [No worker' 13. Otiter �l(fCT comp, insurance] 'Any sPPlicmt that cheeks box #1 must Alm fill out the section below showing their workers' to ;Any who submit this affidavit indicating they are doing an work snd that but �odoo�Y ��tim tContraesM that check this box must attached an outride contractors mot submit a new affidavit h 4cating such. employees. uthe sub 000traaors have l �iy mu sheet showing the name of the sub -contractors and state whether or M those entities have �P ogees. they must pmvhde their workers' comp, policy I eras an employer that is provld&g tvortiers' comp &jorasatiom euadon insurance for my employees Below is the poltry and fob site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip; Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the and a fire imposi fine tip to S 1.500.00 and/or one-year imprisonment, as well as civil penalties ition of criminal penalties of a n the form of a STOP WORK ORDER a a Of UP to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office Investigations of the DIA for insurance coverage verification. f do herby certify and inn nt penalties of perjury that the Information ^. .� � epaiprovided above u tare and eorretx _Phone Ofjlcial use only. Do not turner in this area,• to be complied by city or town ORzdd City or Town: Permit/Ucense # Issuing Authority (circle one): L Board of Health 2. Building Department 3. Cltyfrown Clerk 4. Electrical Inspector 5. Plumbing Itspector 6.Other Contact Person: Phone #: NNERE � 1IMPORTANT DOC MENT'2'201MMMY�i'�� Certificate of Flanle . ResistJance REGISTRATION ISSUED BY APPLICATION s NUMBER V14093 s -' j >: r EVANSVILLE, INDIANA 47725 F121.4 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN Date of Shipment 3/16/2007 Tent Identification This Is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: * 36980 BARNSTABLE COUNTY CORRECTIONAL • 6000 SHERIFFS PLACE BOURNE MA 02532 04459337 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPA184, ULC 109. Serial # 80021000) Description of Item certified: FIESTA TOP 20WX40 WHITE VINYL Flame Retardant Process Used Will Not Be Removed By. Washing And Is Effective For The Life Of The Fabric ///� JOHN HOYLE STATESVILLE NC Signed: - �-! /�' S1ja Name of Applicator of Flame Resistant Finish I ANCHOR INDUSTRIES INC. TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 Telephone (508) 398-2231, Ext. 1275 — Fax (508) 398-2365 /D r &AI y pxv--f7l -,A)gi nl f April 3, 2014 Mr. Carl O. Dumas Kneeland Construction Corporation 407R Mystic Avenue, Suite 34B Medford, MA 02155 Re: Contract Award — Taylor Bray Farmhouse Renovation — Phase II Dear Mr. Dumas, DEPARTMENT OF COMMUNITY DEVELOPMENT On Tuesday, March 18, 2014 at 1:00 p.m. two bids were received and publicly read for the above referenced project. The bid results are attached to this memo. Based upon a review of the bids, and a recommendation from the Director of Community Development, Karen Greene, I have awarded the bid to Project Managers, LLC in the amount of $67,500 which represents the lowest responsive, responsible bid for the base bid plus alternate 1 and alternate 2. Enclosed please find your bid bond. Thank you for submitting a bid to the Town of Yarmouth. Respectfully _ m G. Hinchey Administrator Enc.: as noted Cc: Karen M. Greene, Director of Community Development a:dmtt1Mark'Grylls; Building Commissioner Charlie VanVoorhis, Durland VanVoorhis aace Architects I mil. i Taylor Bray Faun Phase II Bid Opening Yarmouth Town Hall, Room A - March 18, 2014, 1:00 p.m. Yarmouth, MA Bid Farm # Bidder General Bid $ Alternate 1 floors Sub -total with Alt 1(painting) Alternate 2 Total Bid w Altt & 2 Received Ad en 0 m.#1 Bid Deposit 50% Non- Collusion DCAM Certs (if >$100 SZ0 �rc);.t,ded Urb 50 %ndudAd U1, 5Cc7 I �iIc ►cl�ettiltd >tt 33`]$ V NA 2 Knezlol-nd Can.tm, q3,5UO 1L-t ,6OO 0"u7 1/ 3l ✓ ✓ N A. 3 4 5 6 7 - --- 6 9 10 ��nQ till• 3/l6/�y. Procurement Officer Date TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSE7TS 02664-4451 Telephone (508) 398-223I. Ext. 1275 — Fax (508) 398-2365 April 3, 2014 Mr. William Planinshek Project Managers, LLC 15 Lexington Lane - Yarmouth Port, MA 02675 Re: Contract Award — Taylor Bray Farmhouse Renovation — Phase I1 Dear Mr. Planinshek: DEPARTMENT OF COMMUNITY DEVELOPMENT On Tuesday, March 18, 2014 at 1:00 p.m. two bids were received and publicly read for the above referenced project. The bid results are attached to this memo. Based upon a review of the bids, and a recommendation from the Director of Community Development, Karen Greene, I hereby award the bid to Project Managers, LLC in the amount of $67,500 which represents the lowest responsive, responsible bid for the base bid plus alternate l and alternate 2. Prior to signing the contract, you are required to secure and post a Labor and Materials Payment Bond in the amount of 50% of the Contract Sum and to submit the form provided in the Project Manual. The Bond shall be issued by Surety acceptable to the Owner and authorized to do business within the Commonwealth of Massachusetts. In addition to the Bond, you are required to submit insurance policies or certifications. Both the Bond and the insurance certifications may be submitted to the Department of Community Development. Thank you for submitting a bid to the Town of Yarmouth. Town Administrator �' Cc: Karen M. Greene, Director of Community Development � , ,Mark Grylls, Building Commissioner -, p �R wpaw Charlie VanVoorhis, Durland VanVoorhis Architects Taylor Bray Farm Phase II Bid Opening Yarmouth Town Hail, Room A March 18, 2014, 1:00 p.m. Yarmouth, MA # Bidder General Bid $ Alternate 1 floors Sub -total with Aft 1 Alternate 2 aintin Total Bid w AM & 2 Received Add-e_n-aOm,#1 Bid Deposit 5% Non- Collusion DCAM Certs (if >$100 1 3.?Ins _cemmy CS., GTkD \nctx,ded U1150 \Y)C udxd V1, 5-CDd�kt rkd . i V NA 2 Xne�ltxrc� (cX�)Cp *q3/5 O 1y, IQD Idl,b00 11 , 4QD � � � c uO �/ �, ✓ ✓ NA. 3 4 5 .6 7 a 9 10 AL ttiL. Cam'— 3/1 'a/ I Procurement Officer Date I BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR. RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of Yarmouth Building Department 1146 Route `_'8 • N:tnnottth, fitA 0266-l-t492 Tel: 508-398-2231 ext. 1261 Fax S08-398-0836 offce Use Only Planning Board Information Assessors Department Information: Permit NoA ffD Dat 60jri"ement Map cot DatePermit Fee $ / Recording Date New Deposit Rec'd. $ Date Plan No. 1.4 Property Dimensions Net Due $ Other Lot Area (sr) Frontage in) Lot Coverage This Section for Office Use On Building Permit Number. Date Issued: Cettiticate of Occupancy Signature: Bulkling Official Date is is not required Section 1- Site Information 1.1 Property Address: jA^,,,iokkk AAA 1.3 Building Setbacks (ft) ' 1.2 Zoning Information: Zoning District Proposed Use Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water supply (M.O.L e. 40.3 541 1.5 Flood Zone l'nfonnadorc . Corumerft Public Private Zone BFE Section 2 - Property Ownership/Authorized Agent C_ 2.1 O 2 r of R a E M i� 2o�a L Name (print) Mailing s: RTpAENT Signature Telephone Teleph 2.2 Authorized agent: Harne prim Mailing Address: / O�e�ito ^(i7C- yo L{ SignahA Telephone Fax Section 3 - Construction Services 3.1 Lleensod(Construetlouparvisor, l r �} Not Applicable v Y [4LU�C kf`C. 1 J t CFO.,, ` A-j (� �ktwoj&td License Number Address ^Q Expiration Date %nature Telephone 0 1 of 4 OVER 3.2 Registered Hof Cpang Nana o4n oac C^ v Address Contractor. l ., LL.0 Not Applicable U Registration Number / STs-16 M Expiration Daft Z� 5� Signature teieprwne �r{C� xc{ �b S ('t Section 4 - orkers' Compensation Insurance Affidavit (MAL C. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit Will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ....... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35.000 C.f. of enclosed space) Section 5.1 Registered Architect: Address NotAppficable ❑ Registration Number Expiration Date Signature Telephone Section 5.2 Registered Professional En inee s) N Nama Area of Resporaibiity Address Signature - Telephone Registration Numtm Expiration Date Nama , Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of ResponsOWty Address Signature Telephone Registration Number Expiration Date Hama Area of Responsibility Address Signature Telephone Registration Number Expiration Date Section 5.3 General Contractor Not Applicable 0 Company Mama +4 w f A-S Li 19 (C- arson Responsibl 1 buction/ Address Sionature Telephone 7 2of4 Section 6 - Description of Proposed Work (check all applicable) New Construction W (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. 01Repair(s) ❑ Alterations erl Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: Section 7 - Use Group and Construction Type Building Use Group (Check as appricapable) Constriction Type A ASSEMBLY ❑ A.1 ❑ A-2 ❑ A-3 ❑ Al ❑ A-5 ❑ to ❑ 1B ❑ BUSINESS ❑ 2A 28 2C ❑ EDUCATIONAL FF ❑ FACTORY ❑ F.1 ❑ F.2 ❑ H HIGH HAZARD ❑ 3A ❑ 38 ❑ 1 INSTmlTIONAL ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R•1 ❑ R.2 ❑ R-3 ❑ 5A ❑ 5B ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ u UnLJTY ❑ SPECIFY: SPECIFY: SPECIFY: M MIXED USE ❑ S SPECULLUSE ❑ Complete this section if existing building undergoing renovatiorts: additions and/or change fri use. Existing Use Gawp: Existing Hazard Index 780 CMR 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area Building Area Existing (f applicable) Proposed Number of Roars or stories Include basement levels Floor Area per Floor (sf) Total Area All Floors (sf) Total Height (it) Section 9 - STRUCTURAL PEER REVIEW (780CMR 11011) Independent Structural Engineering Structural Peer Review Required Yes ......... No .......... SECTION 10a OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNER' AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property, hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 3of4 OVER 10b OWNER/ AUTHORIZED AGENT DECLARATION L 1, • W,1114"-, `✓ L 1 k-QGJ C , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print • �17���( Signs re of OtneriAgent Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant 1. BWlding 2. ElectricW 3. Plumbing r Gas 4. Medmical (HVAC) S. Fire Protection S. Total . (1 .2 . 3 + 4. 5) 7. Total square FL ckr ti seam a ■amen) - Check Below ❑ Conservation -Commission Fling (it appftcable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 4of4 The Commonwealth ofMassaehusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/organintilon/lndividual): Cl� rrt— 1 I.GI W/�5�11� GL.C. Address:_ j G .��cl•1_c , ..- &Z675, —, Ci /StateM : -An vNo Ma Phone k S K c L(6 11474 n employer Check the appropriate..bo ' Arnam �i 4• I Type of project (required): I . a employer with E'J 1 am a general contractor and 6. ❑New construction employees (fall and/or part-time).* have hired the subcontractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: Building addition ❑ g required:]5. ❑ We are a corporation and its . 10.13Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their I L[] Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required] t c. 15Z § 1(4), and we have no 3a. ❑ I am a homeowner acting as a employees. [No workers'. 13.0 Other general contractor (refer to #4) - comp. insurance requiredl •Any applicant than ch=b box /1 mast also fill out the section below showing then wad=' �sadoe�oliey mfamatimL t Homeowners who submit this affidavit indicating thry are doing an work and then hire outside eonnaetoa must submit anew affidavit indieaCng such. :Contractors that check this boa mast attached an additional sheet showing the name of the soh -contactors and slue whether or not those entkin bave etuplayem if the sub-contotauts have employm they must Provide their wod=e comp. policy mumber Ian an employer that is pwrlding workers' compensation insurance for a•ry employees Below it the policy and Job site informadlom �1 — l N Insurance Company Policy # or Self -ins: Lie. #:_ _ _ 6 k U 6 — S Q SO 7'cal ? _G 0 Expiration Date: / 6 Job Site Address: 16E o /1 Qct kA-AL, 2,o nloj�— City/Staftmp• t04AWDAo . I►/(� Attach a copy of the workers' compensation policy declaration page (showing the policy na her and expiration d2te-Qj.-�I-C7� Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition nrrpo ' ' of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the psi" "pendda �pe# y that the information provided above is true and correct '-1 t Trr a 0► Of jteial use only. Do not write In this area, to be completed by city or town of jiclaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Citylrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Masnci uwm General Laws chapter 152 mqui= all empky&s to provide workers' compeasanon Cos then !doyee& pursuant to this statute, m teplaym is defined as *!.-every person in the service of hotter under any cbatrad of hire, express cc implied, oral or written." An aerlQsr is defined s "1a b&Tidusl, Partoes* usociation, Corpocatan a otherkgmd entity, ar say two arm, xe of the foregoing end m a joint �erpci� and �g tht kVI of a deassad employer: ere this receiver ar tubes of as imsdlridmad, pUtaasb* anocistim a other kid entity, anployNt ecvbyeeL How"m the owner of s dwelling Moss harm= not moss d m tbret apsctmeatt and wbo resides tbaeia6 or the om:paat of the dwelling bona of amtha who employs pawns to do rosiatcaince, construcdon a repair work on such dwelling Muse or on the gtourb at building sppurtrawl thereto shall not because of sack employment be deemed to be an employee M(3L cbspbw lA f25g6) also stets that "s►esy sllae w lscd iken der; agtmey shalt wfthb@W the lssau s W renewd sf a tleenw oe permit to opwab a bmld w toemno- d bW&p la the nmwffwtd& fie my spplkart wbe bore sec produced sasptable ev.Weses of ee mptiasa watt tbs hownce esvertp regmkW Additlandy, MOL cI r I 1A 42XM s scat "Ndtha the comimonweshh nor lay of its political subdivisioot shall eats ism a1y contrsd fct the Pcdzmmm of pubic w at tmtfi sceePtabk evidence of with the iasurmcs Rgaarsmeads of this chapter have bees prod to the coatractliq suttbcrity." Apptkaats Phis fill out .the w0d[a ' compeandue affidavit completelyt by checking the baxss that +PPlY to yoac sitaatim and, if fir, supply sub-eantractor(s) aame(IN addresa(o)1ad Ph= subs(s) abeg with their catiSeste(i) of mmw=L Injmbed LWO:t ► Campania (LLC) t: Liaited Llabr'Iity Partnerships (ELP) with an employees other titan the rocrabas at y am not reqnand to carry worhsa' eonmpeandod Imsaaaea If m LLC air LLP don hew employees; a Posey is regahed. Be advised that thin affidavit may be Submitted 10 the Department of ln&=Wd Accidents for coa&mandom of iassaance cavern& Abe be two to sip and date the affidavfL The affidavit should be, to the city err tows that the appiiead= for the permit or lieanr is being request4 net the Department of ImhzstrW Accidents. Should you have any gaestioma rep:diag the lair cc if yea we required to obtain a workers' . compeassdm Posey, place all the Department at the armbar listed below. SclUnsuaed caa>pania should eats their self-homm ee leeaee amber OR the appropeis- Jim City or Tewa Otfidais Picric be sues that the affidavit is complete and pciated legibly. The Department has provided i space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to eoamd you repadtag the appsanL Please be sera to fill In the per at/lleease nt:mba which will be used as a refetFor e aambm In addition, an apPlicszt that moat eaten! mnttipL past appscatioos is say given Year. nnxd only intuit ooe affidtvit mdicatiag cuQeat Posey h&c=mdm (if neecamy) and tuner "lob Sits Address" the applicant should write "all location la (city or town)." A copy of this affidavit !bet here been affidmfiy stamped at mukzd by the city or mwa miy be provided to the appliant m proof that i valid affidavit is as file fac Atlas permits at lieemes. A new affidavit must be filled out each year. Where Is home owns or cid= is obWning a Ikense at pewit not rehmd to any baaiaas cc caamerelal veae=s (Le. ado, license or pens! ter, barnleaves cta) said person is NOT required to complete this sfsdavit The O@tce of Iartstipmttions would hYeto !hauk you in advance far yaw cooperation and should you hew say gasestioos. please do not hesitate to give us a all rho Depsrtmeat's addresstelephone and fax amber: 'kite Cotmnomealth of Mmuhusetb . Dqufted of Industrial Accideab OMM of fim"tiptieaa 600 Washington Stft:et Boston, MA 02111 Td. if 617-7274900 tact 406 or l •977-MASSAFE Revised i 1-22 +)6 Fax M 617-727-7749 www.man.gov/din TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM:• job Location:_ Street Owner of Property. Construction Supervisor. Address: -1KZ6 License No. Phone No. Ar\V%Aca�OAY— Mg oz6 -a- Licensed Designee: (If other than Supervisor) Name - License No. 2.15 Responsibility of each license holder. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is- not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4Any licensee who shall willfullyviolatesubsections 2.15.1,2.15.2or2.15.3oranyother section ofthese rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current li Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yu, please indicate th a coverage by checking the appropriate box. A liability insurance policy , Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ Signature: Building Official Approval: '• _o TOWN OF YARMOUTH C BUILDING DEPARTMENT o y 1146 Route 28, South Yarmouth, MA 02664 .�r'508-398-2231 ext.1261 Fax 508-398-0836 DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111 S, I hereby certify that the debris resulting from the proposed work/demolition to be 4-4- conducted at�/6� f/ � ll �o VA `" ` �� Work Address Is to be disposed of at the following location: ,L w Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Sign • Wre of Applica on ! V Permit No. Date 0 l "( Massachusetts - Department of Public Safety v Board of Building Regulations and Standards Construction Supcniw,r License: CS-095981 'v WM IAM F PLANNSHEK 15 LEX iGTON LANE YARMOUTH PORT MA 02675 Expiration Commissioner 10125/2014 Office of ain & Bostc atkrdasc!!1: ..Sic 1NPR0NEl1 �TZuL600 egista8on:_ L y� - raBon::=:5/752Q15 Type: PROJECT _ _ .. LLC NtANAGERg L1 C -_ h?UJAM PLANINSFiEK x 15 LDCENGTON LAL - - . EARMOUTFipORTMA 0267 �- 11 �� dersecretaq PROJEA OP ID- PS ACORN- •�� CERTIFICATE OF LIABILITY INSURANCE DATE (NM/DO 1o12812013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES _ BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subjact to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). PRODUCER Edward J. McGrath Insurance P.O. Box 1003 Dennis, MA 02638 E.J. McGrath Insurance Agency CONTACT - NAME: Patricia Sanzo PHONE • 508385-2454 Ne : 508385-5991 E•MaL ADDRESS: INSURERS AFFORDING COVERAGE NAIC f INSURER A -The Travelers Insurance CO. 101898 INSURED Project Managers LLC 15 Lexington Lane Yarmouthport, MA 02675 INSURERR: msuRERc: - INSURERD: I INSURER E: INSURERFt ' 17r1VF0AnPF CFRTICIC ATC IJIIMRCD• ommal 1a1 a111ARRCD• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY .THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR E :ADDL SUB LC LTR- TYPE OF ItSURANCE POLICY NUMBER 1121 L EXP MM�DDI`(Y ( LIMITS - - GENERALLIABILIT'/ EACH OCCURRENCE is " !COLe.7ERCUIL GENERAL LIABILITY 1 REMISES Maoxvrerx:e ' S S ' ^� CLAIMS -MADE 1 OCCUR i - ; I MED EXP (Any one peraoni S PERSONAL S ADV INJURY S CENERALAGGREGATE I G WL AGGREGATE LIAT APPI IFS PER I i ; : PRODUCTS-COMP/OP AGG { S POLICY { I PR0. ' IOC ! i 3 I AUTOMOBILE LIABILITY . _ I EaMacBINIED citle,SINGLE LIMIT EiANY AUTO I = _ j 1 BODILY NJURY(Perperwn) S . ALL OWNED -r SCHEDULED I j AUTOS I iAUTOS i - .( j ` BODILY INJURY(Paraccidert) S HIRED AUTOS NON -OWNED , , I . AUTOS ( I - PP2(SPER DA E ERA IDENT I S UMBRELLA LIAR i OCCUR( � � � j - EACH OCCURRENCE` S EXCESS LIAS I CLAPMS4MADE.. I - . .AGGREGATE S LIED RiWNT10MS I ` I I - S I WORKERS COMPENSATION I I - I WC STATU- X OTH• - AND EMPLOYERS' LIABILITY YIN 1 IFR A ' ANY PROPRIETOR/PARTNER/EXECUTNE 1 16KUB-SB$0797 8-13 10/2O/2073; 10120/2014 ELEACHACCIDENT : S 500,000 OFFICERMEMBER EXCLUDED? Y NIA i - �(MandatoryinINN) E.L.DISEASE-EA EMPLOYEfl S 5DO,00 IDESCRIPTION OPERATIONSbelow ( E.LDISEASE- POLICY LIMIT S - 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Adaitimal Ramer" Schedule, IT alc.. apace Is "irad) William Planinshek has not elected Workers Compensation coverage. V CR IIrIVHIC rIVLV CR VAIYI.CLLMIIVM YARMTO1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 .. S Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE E.J. McGrath Insurance Agency 01988-2010 ACORD CORPORATION. All rights reser/ed. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Official Use 0111 Department of Fire Services Permit No. �27 i Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 01/10/14 City or Town of .. Yarmouth To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. O�i ton (Street & Number) 108 Bray Farm Road North er or Tenant The Barn Telephone No Address permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) ie of Building C9uarret� f%M4v, Utility Authorization No. ig Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters ervice Amps Volts Overhead ❑ Undgrd ❑ No. of Meters of Feeders and Ampacity i and Nature of Proposed Electrical Work Wiring for boiler and CO Alarm. ofthe followine table may be waived by the Insneuor of tires No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fan o. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires _ ..__ - - Swimming Pool . ove n- md. d: o. o Emergency ig mg __._. Batte Units No. of Receptacle Outlets No. of Oil Burners LARMS ., No. of Zones No. of Switches - No. of Gas Burners INo. on an a evices No. of Ranges No. of Air Cond. Tons'I otal ing i e No. of Waste Disposers eat ump Totals: umber onso. o e - o etection/Ale ' No. of Dishwashers Space/Area Heating KW Local ❑ unicipa Connection No. of Dryers Heating Appliances KW Security ystems: No. of Devices or E uivalent No. of Water KW Heaters o. o o. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunicauonsWiring: No. of Devices or Equivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector ofWres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 01/06/13 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed a ation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited roof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER. ❑ (Spe ify: I certify, under the pains and penalties ofperjury, that the informali n o this application is 1 and complete. FIRM NAME: SDM Electric, -Inc. - - " "" ' LIC. NO.: 18338A Licensee: Scott D. Morris -- Signatur LIC. NO.: - -- -- (Ifapplicable, enter "exempt" In the license number line) : Bus. Tel. No.: S08 430 4014 Address: PO Box 1264 East Harwich MA 02645 ' Alt. Tel. No.: 774 353 6902 *Per M.G.L.c.147, s. 57-61, security work requires Depa a of Public Safety "S" License: Lic. No.: OWNER'S INSURANCE WAIVER: I am aware that the censee does not have the liability insurance coverage normally re- quired by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's a ent Owner/Agent PERMIT FEE: S Signature Telephone No. - of TOWNOFYARMOUTH �uiidingDepartment' BUILDING (508) 398-2231 ext.1261 PERMIT NO PERMIT ISSUE DATE ; _ 8/22/4013 _ : PROPOSED USE ; APPLICANT .Master Gardeners Club - --, J WEATHER CARD ----------------------------- PE! MIT TO Misc.ltent AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE= USE GROUP LOT SIZE 0 CONTRACT erect temporary tent - 08/23/13 - 08126113 - Master Gardeners Picnic REMARKS AREA (SQ FT) EST COST ($ I$PERMIT FEE ($) $35.00 OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146Route28 OR LICENSE O lBamstable County Sheriff I I 6000 Sheriffs Place Bourne MA South Yarmouth MA 102664 1 PHONE 15083982231 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector 't of 1P%01, TOWN OF YARMOUTH Building Department BUILDING _ _ . _ _ _ _ _ , (508) 398-2231 ext. �- PERMIT NO _ _B-14-335 _ PERMIT ISSUE DATE :_ _91512013_ _ : PROPOSED USE APPLICANT _SPERRYTENTS _ JOB WEATHER CARD PERMITTO MiscJTent AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONS T TYPE 5-B USE GROUP R-3 LOT SIZE I I TEMPORARY TENT — Construct 46' X 85' Tent from Sept.12 thru Sept 14th (EVENT held on Sept REMARKS 13th) Per 780 CMR MSBC and Town of Yarmouth Zoning Bylaws AREA (SQ FT) EST COST ($ $19,000.00 PERMIT FEE ($) 535.00 OWNER AYLOR BRAY FARM BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH YARMOUTHPORT I MA 102675 INSPECTION RECORD PHONE CONTRACTOR LICENSE 0 FIELD COPY Date I Note Progress - Corrections and Remarks I Inspector —czv i5 of TOWN OF YARMOUTH Building Department ' !' ®' V BUILDING .. _ . _ _ , (508) 398-2231 ext1261 '- PERMIT NO - _ .:: .3 . _ ' e PERMIT ��• ISSUE DATE :_ _91512013- .: PROPOSED USE _ _ _ . _ .. _ _ APPLICANT 'SPeRRirTai'i§ - - - - - ---------------------------- - - - - - - - - - - - - -; JOB WEATHER CARD PERMITTO Misc/Tent AT (LOCATION) ZONING DISTRICT= Bldg. Type: Residential 10108BRAY FARM RD NORTH SUBDIVISION MAP LOT BLOCK 151.24.1 LOT SIZE F BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R3 TEMPORARY TENT — Construct 46' X 85' Tent from Sept. 12 thru Sept 14th (EVENT held on Sept REMARKS 13th) Per 780 CMR MSBC and Town of Yarmouth Zoning Bylaws AREA (SQ Ff) EST COST ($ 319,000.00 PERMIT FEE ($) OWNER AYLOR BRAY FARM BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH YARMOUTHPORT MA 102675 CONTRACTOR LICENSE PHONE I i THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. . POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS N t, g . gx 4 u t141'eFJ 3 OTHEK4 2 3 4r)0 5 Wx WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRIITEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 PERMIT NO B-1435 = PERMIT ISSUE DATE : 91512013_ : PROPOSED USE _ _ _ APPLICANT 'SPERRYTENTS - - - - - - - - - - - - - - - - - -- JOB WEATHER CARD PERMrrTO ' Mis' .l nt ------------ I AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type: Residential I SUBDIVISION MAP LOT BLOCK 151.24.1 LOT SIZE BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R.i TEMPORARY TENT — Construct 46' X 85' Tent from Sept. 12 thru Sept 14th (EVENT held on Sept. REMARKS 13th) Per 780 CMR MSBC and Town of Yarmouth Zoning Bylaws AREA (SO FT) EST COST ($ 579,000.00 PERMIT FEE ($) 535.00 OWNER AYLOR BRAY FARM BUILDING DEPT BY ADDRESS 0108 BRAY FARM RD NORTH YARMOUTHPORT MA 102675 YOUR SPECIAL ATTENTION is called to the following: PHONE CONTRACTOR LICENSE 0 This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this jurisdiction including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit Is issued must be displayed on premises. The Department must be notified and inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimum of three called inspection, namely, 1) Footings, drain tile systems, foundation and basement walls, when wails are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanical systems are installed. 3) Final inspection when building or structure is completed. On jobs involving reinforced concrete work, inspection must be made after steel Is in place and before concrete Is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been inspected and approved by the Department in accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee is also charged predicated on the extent of the variation from the original plans. Permits are not valid If construction work Is not started within six months from date permit is issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been installed. Painting or decorating is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY ' vatm tote ury itfrnl[� � "✓ S Fae S itxmu e1pfrm 6 mccdts Umm kme datr EXPRESS BUILDING PERMIT APPLICATION TOW, J OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth. MA 02664 (508) 398-2231 Ext. 1261 CON3T MMON ADDRESS: ASSESSOR'S L`TFORmATiON: 0%%N t: CONTRACTOR: __j NA. Map: zLd sufr Af7ORiSS \o cc)L q4 TEL . V-i 1 Dtn,tic, wuRf t� /Xh 0 5571 7U-' — "si al Cammetcial Em Cou of cou=uctiCn 110ttte lmprovtment Contractor Lir— k Ca,utmction Supervisor Lic.It r_ iVoAZ=*s Corapensaoon [==cc: (chcctc one) 1 am the 4omeowner 1 am the sole prnrdeor t [anti Warkees Compensation lasus2nce lnn=weCoaVaeyName 1 wotker'scon*.ft -F glla`13 «*ARK TO M PERF•ARMED J �cnt(I�meRetard:mtOittCaylean�,f)`,' Q L:WondStue SItM CSr=s: onf. W 1143 57uev' «i clLtT, fSRrptxcm=dom: # Irltephtrntst�iato.vt;► ❑Ren+of: oofSqum () Str;ppins ot, ihitg]a- -7t %k4wis win M dlgwmcd afar. s famtlzivt t) Subs mw_ktyen ccetistins roof D t7st K4rts ttishwayil [istoric Disuxt R4k'rwwmf: (ilk[ far! lnet t In bbejust alt te nndepeeies of i`TPrYui th tte ttzeaKnts [xselo wit! e mined me Itm nc and eat to 6 c Oat of my k:xmkdae WU OeLaL f u"wmd tha am Disc rswens) tamc fer denial a rcwocton of my Eicrrse aed fer lwoxration tsakf MQL CT, �68. Smiv 1- wcTl;csnracam, 6Daw �3 o..ners sgtstare (or attcfia„t) r J 0.ikrml0"kW tardouckv) lTdSC RECEIVED l��f� c SEP 0 5sy 2013 SUILDI 7"Al is District._ 1%smfita! Disaiec Yes No kvxef Resource Pmmctian DIstficr. Yes No pia! PLba Zone: Yes No Within 100 & of %vctL-4&: Yes No ` 101 , Certificate of Flame Resistance Manufacturer Number Sp eny Sails Date of Manufacture 577 28Jan-09 11 Marconi Lane Marion, MA 02738 (508) 748 - 2581 This is to certify that the materials described have been flame-retardant treated or are inherently non-flammable j and were supplied to: Certification is hereby made that: The articles described on this certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code equal to or exceeding NFPA 701, CPA184 Method ofApplication: Coated Fabric Color, Type and Wel hl Oyster, Polyester 7.2 oz Description of Item Certified: 46x85 ft. Pole Tent Flame -Retardant Process Used Will Not Be Removed By Washing And is Effective For The Life Of The Fabric Kolon I >V • U/// Z/ I 7 (gertifiCate Of Manic IVAStaUCt marmAmbn SPER.RY LaS °'�°`' Zy$ ] 1 Marconi Ln Box 215 ��' 03 Marion, Mass 02738 - D0.QIiiS-43R1... 7jc 0a 60.9/7'tR3'[R srclx srerrYut>s.eom sperr,satls&apeeeA.uet This is to certify that the materials described have been flame-retardant treated (or are inherently nonflammable) And were supplied to: NAME: CITY STATE Certification is hereby made that: The articles described on this certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal �i Code, equal to or exceeds NFPA 7019 CPA] 84 �T l b7 Method of application: �OA� Type, color, and werghtof aaevasm'W - ,01�L� -7.sL c* vatl4r O tAFR °g�p,�o Wr0 Vtrlt�iloti % - .. _ _ ..■_■■ tt.■.a a.. Flame Retaraant rrocess wawa+ ..a■■ •-%PR6 -- Removed By Washing And Is Effective For The Life Of The Fabric ame of ---oCFFLUM r Colo Signed: SPERTEN-01 MEMA ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE (M� MID» 8=12013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement an this certificate does not confer rights to the certificate holder in Neu of such endorsement(s). PRODUCER (508) 676-0309 Viveiros Insurance Agency, Inc. 375 Airport Road Fall River, MA 02720 NAME: Marie Mello PHONE 508.676.1075 No __ MAIL ADDRESS: mmello@viveiroslnsurance.com INSURE 3 AFFORDING COVERAGE NAIL! INSURERA:Peerless Ins Commercial Lines 24198 INSURED Sperry Tents Inc. Po BOX 10 Rochester, MA 02770 INSURER B.Technology Insurance Company INSURERC: INSUIIERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLTR TYPE OF INSURANCE im POLICY NUMBER MMIDDrYYYY) (MMIDDIYYYEXP LISITS A GENERALLLIBI ITY X COMMERCIAL GENERALLUBILTTY CLAIMSa.UDE FX-1 OCCUR 4U9986 10H512012 10115@013 EACH OCCURRENCE $ 1,000,000 DAMAGE IIJRENILL) PREMISES *xwerce $ 100.0 MED EXP (Any on* person) $ 5,00 PERSONAL d AOV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GENL AGGREGATE LIMIT APPLIES PER PRO- LOC X POLICY JrCT PRODUCTS-COMPIOPAGG S 2,ODD.00C S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRFA AUTOS X AUTNON�OWNED BA4549982 10115/2012 10/1512013 COMBINED SINGLE LIMIT Fs *cadent 1,000,0 BODILY INJURY (Per penan) S BODILY 24AIRY(Per *CJdere) S X PROPERTY Eal� $ Included S UMBRFl 1 a LIAR EXCESS LIAB CLAIMS MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTIONS S B WORKERS COMPENSATION AND EMPLOYERS' IIABRITY ANY PRCPRIETORmARTNERIEREamvE YIN OFFICERIMEMBER EXCLUDED? r (MwKlatwy In NHl I yes OescrlDe lXlder OESG�RIPTION OFOPERATIONS below MIA TWC3335963 1011512012 1 OH SM13 WC STATII- 01n1- UMTST EL EACH ACCIDENT S 500,00 ELDISEASE-EAEMPLOYE i 500,00 EL DISEASE -POLICY LIMR S SOO,OO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ABx11 ACORD 101. Additional Remrks SCledrs*, I more spat* Is recIdmi) Hayley Winfield Taylor Bray 108 Bray-Faffn Rd Yaffnouth Port, MA 02675- SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �ysr�+,rt. YI •iN'�A� �• c L0 01988-2010 ACORD CORPORA ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth ojhiassachtrsetts Department of Industrial Accidents Office oflnvestigadons 600 Washington Street Boston, MA OZlll www.mass govIt is Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lmibly Name a �_4_t City/State/Zip: A �Ke` , 0Osbm W CA71 Phone 7H g 7 9 Are you an employer? Checkthe appropriate box: Type of project (required): 1 I am a employer with �', 4. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).' 2. ❑ 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These subcontractors have 8. ❑ Demolition working for me in any capacity. insurance workers' comp. insurance. 5. ❑ We are a corporation and its q. ❑ Building addition [No workers' comp. required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. insurance t c.152, § 1(4), and we have no employees. [No workers' 12.❑ Roof repairs 11 required.] comp. insurance required.] 13. Other TnT *Any applicant that clucks box # 1 must also fill out the section below showing their workers' compensation policy idbanatioa t Homeowners who submit this affidavit indicating they m doing all work and then hire outside contractors must submit a new andavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subtontraeton and theirworkers' comp. policy information. lam an employer that is providing workers' compensation insurance for M employees. Below is the policy and job she brformadon. \ — Insurance Company Name: � C tL en 5 Ttt�t1 5 Policy # or Self -ins. Lic. #: W C 33 3 e 3 Expiration Date 0 i S Job SiteAddress:_� Attach a copy of the workers' compensati n policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby urtjt under the pains apd penalties ofpedury that the information provided above it true and correct O,(jrdal we only. Do not write in this area, to be completed by city or town o iddd City or Town: Permit/Ilcense # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: 07/19/2010 11:48 5084185057 AJLLIKES PAGE 03/03 •'87/19i2018 10:45 812-867-8547 ANOM Its PAGE 82/02 IMPORTANT DOCUMENT Cenif wte of Flame Psistance Dete s ► atShlpmarl ISSUED BY 06f11O Registration Number 1 DUSTRlE9 1 ® Tentidenthtcatlon F-1�110 14876250 EVAN;NSLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been Hanle -retardant treated (or are Inherently noninflammable) and were supplied to: BEST ADVERTISING DISPLAY 511 MAIN ST WEST YARMOUTH, MA 02673 2�-MN' Certification Is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with Califomla Fire Marshall Code. All fabric has been tested and passes NFPA 701, CPAI 84. Semal0 81059®3 (6) Descriptlon of Kam certified: TENT WALL VIOX20 WHITE VINYL WITH s CATHEDRAL WINDOWS RECEIVED SEP 05 2013 BUILDING DEPARTMENT ey- Flame Retardant Process Used Will Not Be Removed By Washing And is Effective For The Life Of The Fabric TRIVANTAGE STATESVI LL E NO t4rrr_ or Applicator of Flame Reclstant Finish Signed: /� 1944 AN HOR INDUSTRIES INC ' 07/19/2010 11:48 5084185057 AJLU<ES PAGE 02/03 4 0'.1A S/2010 10:45 812-867-0547 ANC" Its FAGS' 01/02 � IMPORTANT +/DOCUMENT gry cewfxate of :L'rame ance Data of Shipment , ISSUED BY 00/11M0 R-gistratlon Number INDUSTRIE�I ® Tent IGedffiwlion f-tz�10 14875250 E'VANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the rnaterials described have been flame-retardant treated (or are Inherently nonintlemni-able) and were supplied to: BEST ADVERTISING DISPLAY 511 MAIN ST WEST YARMOUTH, MA 02673 4� Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant apprcved chemical and that the application of said chemical was done In conformance with Callfomia Firm Mamhall Code. All fabric has been tested and passes NFPA 701, CPAI 84. Serial T SOM100 t1J Deicription of Item certified: FIESTA TOP 20WX40 WHITE VINYL - Vd PZECEIVED SEP 0 5 2013 BUILDING DEPARTMENT 13Y Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric TRIVANTAOE STATES LV�LENC Name of Applicator of Flame Resistant Finish 14 Signed: o' - is 914 ANCHOR INDUSTRIES ING - GOWNERADDRESS TYPE OR - PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FLITTING WORK CITY I Yarmouth MA DATE I January 2 2014 1PERMIT# JOBSITE ADDRESS 108 B Farm Road OWNER'S NAME Town of Yarmouth I TE FAXO OCCUPANCYTYPE COMMERCIAL[] EDUCATIONAL RESIDENTIALM _ NEW:❑ RENOVATION: ❑ REPLACEMENT: El PLANS SUBMITTED: YES NO❑ APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BOILER _ BOOSTER -- — — -- — CONVERSION BURNER —f— — -- — — COOK STOVE - DIRECT VENT HEATER — — DRYER FIREPLACE11 FRYOLATOR FURNACE 1 GENERATOR GRILLE - - INFRARED HEATER — -- — LABORATORY COCKS _ MAKEUP AIR UNIT OVEN — — -- -- - — POOL HEATER - - -- ROOM / SPACE HEATER _ - ROOF TOP UNIT _ — TEST UNIT HEATER - — -- — - — — — -- — — -- vINSURANCE COVERAGE lot su nce poiicy or substantial equivalent which meets the requirements of MGL Ch.142 YES Q NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I William Heath LICENSE # 12021 SIGNATURE MP El MGF❑ JP❑ JGFM LPGIF-1 CORPORATIONQ# F.3-4-87C--'-i PARTNERSHIP❑#r,------lLLC❑#0 COMPANY NAME• Murphys I ADDRESS F34 Whites Path CITY South Yarmouth STATE ® ZIP 02664 TELJ 508-760-1660 FAX 508-7601670 CELL�EMAIL Itetrault@callmu h .com 6PI'll ROUGH GAS INSPF.CTTON NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPEMON NOTES �% Yes No �'/lq-e, iYf�.fl '�/�`OIA THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES t i. ii h T 1. J r � i u i Y _ � i+ 6 u �y y of r TOWN OF YARMOUTH Building Department .......... (508) 398-2231 ext.1261 PERMIT NO :_ B-12-1577_ ISSUE DATE :_ _615/2012_ _ ; PROPOSED USE ------------------- APPLICANT .Chase Canopy BUILDING ----------- PERMIT JOB WEATHER CARD PERMIT TO ' Misc./tent I AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: LOT SIZE E erect temporary tent -11th Annual Sheep Festival REMARKS OP AREA (SO FT) EST COST ($ $0.00 PERMIT FEE OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH Yarmouth Port I MA 102675 USE GROUP PHONE CONTRACTOR LICENSE 0 Chase Canopy Co. 4 Nlcky's Lane Mattapolsette MA 23790 5087582055 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector 0 of TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 PERMIT NO B-12-1576_ • r� ISSUE DATE ;. _6%5j2012_ _ ; PROPOSED USE ;::::::::: _ . PERMIT APPLICANT Bamestatile 'County Sheriffs JOB WEATHER CARD --------------------------- PERMIT TO Mlscltent AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICTEE Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 15124.1 LOT SIZE erect temporary tent -11th annual Sheep Festival REMARKS BUILDING IS TO BE: CONST TYPE" USE GROUP AREA (SO FT) EST COST ($ $0.00 PERMIT FEE OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH Yarmouth Port I MA 102675 PHONE CONTRACTOR LICENSE 0 . Samstable County Sheriff's De 6000 Sheriff's Place Boume MA 02532 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector ELBSUILDICNG EIVED Office Use Only r�,(j t �S02 2011 Amain `�-° ires 180 days from DEPARTMENT EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 ; • .�1-l�i1C,l.� South Yarmouth, MA 02664 r (508) 398-2231 Ext. 1261 CONS;r UMON ADDRESS: l (�� g� ►� t/ �e�-l� �a A�a r� T/{ ASSESSOR'S INFORMATION: Map: {S Parcel: 2 OWNER: t / 0 f= v4em NAME PRESENTADDRESS TEL # CONTRACTOR: � A /%L /�✓ r am. NAME MAmNe—AgbRESS TEL # Residential Commercial Est. Cost of Construction $ Home Improvement Contractor Lie, # Construction Supervisor Lic. # Wodaaiiin's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor Insurariee Company Name: Tent Duration Siding: # of Squares Roofitib: # of Squares I have Worker's Compensation Insurance Worker's Comp. Policy# WORK TO BE PERFORMED (Fire Retardant Certificate attached?) Replacement windows: # ) Remove existing* (max. 2layers) — Old Kings Highway/Historic Dist. ( ) Replacing like for like *The debris will be disposed of at: Location of Facility Wood Stove Replacement doors: # Insulation I declare tinder penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation of my license and for prosecution under MGL Ch. 268, Section 1. Applic8nctSiegnature: • Gifize id S08 -888. ��, N Owner's Signature (or attachment); l Ckw& [c- 1& CIA Date: Approver! By: Date: Building Official (or designee) Zoning District: Historical District: X44 No Flood Plain Zone: lfs No Water Resource Protection District Within 100 ft. of Wetlands: Yes No Yes No The Commonwealth ofllfassaehusetis Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia or ers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):. Address: t..ttyiOtdte/Zap: Phone #• Are you an employer? Check the appropriate boz: 1. ❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).; 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity.. (No workers' Comp. insurance i 3. El am as homeowner doing all work myself. [No workers' comp. insurance required.] 1 3a. ❑ I am ahomeowneracting as a general contractor (refer to #4) have hired the sub -contractors listed on the attached sheet. These sub -contactors have employees and have workers' comp. insurance.: 5. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comb. insurance reauired_1 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other ;Any applicant that checla lox #1 must also fill out the section below showing their workers' corapensatiodpt olicy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside comtactnts mast submit a new affidavit indicating such. 2Contracters that check this box trust attached an additional sheet showing the name of the sub -Contractors and state whether or not those entities bave employees. If the nub -contractors have employees, they must provide their workers ' comp. polity amber. I am an entploy'er that is providing workers' compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of penury that the information provided above is true and correct Signature: Date Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. CityfTown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person • Phone #• Information and Instructions ' Musaehusem General Laws chapter 152 requires all emploYdrs to Provide workers, compeasaaoa for their employees i Pursuant to this statute,an is defined as "...every person in the service of another under any contract of lute+ � express or implied. oral or written." is defined L "era i�ivtdusl, Pu p. assocrst . corporahoa or other legal entity, or any two a morn An cacprgw of a deceased employer, or the of the foregoing engaged in a�amt eaberpcise, and in chiding the legal rcpr receiver at trustee of in individual, Partnerships ti0° or other legal entitye employing emQloyem Ho*Rvsr rite house having not more than three and who resides ffi= n, err the occuParr of the owner of a dwelling , ns to do maiateasace. construcon tior repair work on such dwelling house dwelling house of another who employs peso wed to be in employer." or on the grounds or building appurteatat thereto shy � because of such employment be " state er Ioeal lkeaslag spaey shall withhold the luus a or iViGL chsPe:s 152. g25C(� :Igo states that rn4 Ls the eommoawsalth foe asq . renewal of a Ikense oe pest to operate a buslaen or to eorsbud bdldlIP « acceptable evidence of compliance with the Iasuases �N rM� appikaad 17, O net per 152, states "Neither the commonwealth rice any of its political subdivision shell AdditioasIIy, MGL chapter 152. 425C(7) of public wart until acceptable evidence of complilace with the insurance eater into any contract for. the performance requirerov.* of this chapter have been presented to the contrwting sr tY•" Applicants . affidavit complately►, by checking the bones that apply to your situation and, if. Please fin out the wort tea' COTIVI satin s with their certificste(s) of -watr necesssrp, supply sub ctor(s) nsme(s), address(es) and Phan number(with no employees other then the ia:ta:nes: Limited Liability Codes (LLQ or Limited Liability Put omhrgs (LLP) members pa�� era Dot s� to � we�a. � . liar LLC er LLP does tsrta or be submitted to the Deperb of Iadust:iri ezmby�. a policy Is regared. Be advised tier this s® be s may A� for con&-mratkm of ftw=n e coveage• Ales be Bart to lip and data the a1<Sdamrt6 the eputrit t Of be retsan:3 to en city or town that the sppii 4dm for the permit or lir-eaas is being requester ��°� a Industrial Acciaerft Should you have say q the lea cc if you sm regtared lesae tail the Department at the number listed below. Self -insured companies should eater their tom [tr�M � an the soccv0dift RM City or Town Ott3clab Plessa be sae than the afndavit is comp lets and Printed legibly. The Department his provided a sPwo st the bogie of the &Mdavit for You to fill out in the event the Office of Investigations ban to conttd you regarding the sPP� Plessa be sure to fill in the Permit/Iicema mnaber which will be used as a mferenca number. In addition, la aPPIkUlt that wait submit =114& permit/licensa applicad= in any given yes, reed only submit owe atidavit indicating current pow iniormatim (if necessary) and under "Job Site Adds+" the applicant should writ* " a1l kcatbas 1n (city or ac muted by the city or town tiny be Provided to the town)." A copy of the affidavit that has been officially stamped is an file foe a applicant a proof or eases. A trees affidavit must be filled out each that i valid ffidavit future permits year. Where a home owneror citizen is obtaining a license at permit not related to any business or commercial veahre - - perm dof license or it to bum lea res etc.) said person is NOT required to complete this affidavit. The Oflics of Investigations would liketo thank You in advance for Your cooperation end should you have any glmestioas. please do not besitafe to give us a call the Department's address. telephone and fair number. The Commonwealth of Mauachttsetts Department of Indttsbial Accidents Me of Investlptions 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-btASSAFE Fax 1) 617-727-7749 Revised 11-224)6 www.mass.gov/dia IMPORTANT DO OMENTOMMEMPOPM', Certificate of Flanle Resistance REGISTRATION ISSUED BY APPLICATION a ' st YMNES09P NUMBER• i EVANSVILLE, INDIANA 47725 F121.4 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN Date of Shipment 3/16/2007 Tent Identification 04459337 This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 76980 BARNSTABLE COUNTY CORRECTIONAL 6000 SHERIFF'S PLACE BOURNE MA 02532 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. Serial # 8002I00(1) Description of item certified: FIESTA TOP20WX40 WHITE VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric nn 1OHN BOYLE STATESVILLENC Signed:-�' �Iln Name of Applicator of flame Resistant Finish I ANCHOR INDUSTRIES INC. Jun 0512 09:51 a Lynn McIntyre 508385-9407 p.2 umee use unq �. Permit k . Foe S Ci H Pami[espites 6 monthsftom EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: !C6 y dlezf7kf ASSESSOR'S INFORMATION: OWNER: C k.'/! d NAME CONTRACTOR: NAME Residential Map: S / Parcel: P / �f•f,v��1. (�.�/...-_ �;,,,. fir, I ADDRESS TEL ft Commercial 0 Est. Cost of Construction $ Home Improvement Contractor Lk. # Con truction Supervisor Lk. It Workman's Compensation insurance; (check one) r7e-f -/'�r In if t ai7 a:S 1 am the homeowner I am the sole proprietor I have Worker's Compensation Insurance`.,, �i f iLi, Insurance Company Name Worker's Comp. P0lu7li // NVORK TO BE PERFORMED BTmt (FteRerardantCertifuarcatruhad) 3 Wood Stove Shed 0Siding' &orSgrrJrrrs C Replaomntdoors: ♦ C Replac°mmtvdadowr•M ❑ Re -roof: I arSq=ms O twulatian () Suipping old Shingles, () going ova--jaye s of existing roof ❑ Old Kings F ighaay/Nirtorie Diana Roofing/Siding (1J1se for Uke) `M debris will be disposed of at: Location of Facility 1 docktre under peaalti s of pajury that the statements herein coarainerl are true and Corsets to the best of my knowledge and beIId. I undentwo that way false aaswc(s) will be jua cause for denial or revocation �ojff my liter- anzi for prosecutionn under bEG.L Ch. 26L Section I. -t^ Applicaaa's Signamtc nc la �' �w 3 L lad r !� r� 7 ,'-•z• i uf: r I . Zc^ 17 r Darr. ormen Stgpnterr (err attachment) Dew. Approved by. Due: Building Official (of dedgaoe) Zo`n'ing District: Historical District: YIS No _ Flood Plain Zones Yes I�o Water Resoutse Protectio�nDistrict Within 100 ft. of Wetlands. '/''^ \ Ill Yes — Yes Xo 101 Jun 0512 09:52a Lynn McIntyre 508-385-9407 p.3 1 . '. ; I The Commonweauh ofMasaachusdts Department oflndttUPWAecidents ofceofrMwifgatl'ons ` 600 Washington Stred N Bastm4 MA 02111 . V R:X' www.ma&%gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrfdans/Plumbers Applicant information Please Print Lembly Name (Bosiness/Qreaav owUdividual): Address: -`'sayr%Jtatae.sp: Phone #• Are you as employer? Check the appropriate box: 1. ❑ [ am a employer with 4. ❑ I am a general contractor and I employees (fall and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required) 3. ❑ l am a homeownerdoing all work myselL [No workers' comp. insurance required.) t 3a ❑ I atn a bomeowner acting as a general contractor (refer to #4) have hind the sob -contractors listed on the attached sheet These sub-conhactorg have employees and have workers' comp. imsumnce.t 5. 13 we are a corporation and its officers have exercised their right of exemption per MGL c. 152, f 1(4), and we have no employees. [No workers' comp, ine*Rnce reCuvedl Type of project (regalreM: 6. ❑ New consUmion 7. ❑ Remodeling S. 0 Demolition 9. ElBuilding addition 10.0 Electrical repairs or addition I i.❑ Phunbing repairs or addition 12.❑ Roof repairs 13.0 Other ;Any applicsal that chad- bmr Yl mint dw U Out the secdm belm i t HomeoWMU who VAIrsit this a87davh iodiotta<they am �iwroam, ,epoxy kAmadon. tCootractan that Meet this boat oast attached sa additional sheet Mort and d►ea bins outside eoottaetors mast submit a asw atlSdarit iadicart+ta aueb. eagrbyem if the mb-0oatnctoo beta employees, they moss � the acme of the won and staea whaher cram thoaa eatitka have prorida &eQ aso.km eomp.yeiiepo®r>Q I pas arc taspkoyer the is pr»vldbta mwntas' ronrpenmdlon lesaramo or Informed" ! +try erg fooytes. Below B the policy and job s11e Insumucc Company Namr. Policy 0 or Self -ins. Lic. N: ��on Da Job Site Address: Ctq/Statdmp: Attach a copy of the porkers' compensation policy declaratloa page (showing the polky camber and espiratloa date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1.500.00 and/or one-year imprisonment, as well as civil penalties a STOP WORK ORDER form of a� a fine is the of up to 5250.00 a day against the viola w. Be advised that a copy of this scat 0 the may forwarded to the Office a Investigations of the DIA for insurance coverage verification Ike hereby «rtfh under Me Pala and peiralAw ofpedcry lkst the lnfatrrsadorr prertded eboMIS trov and awrr[d uaattae: Dave Phone f: AkiFtote OB4% Do not wrht In 1Ah arts, to be eornpk&d by cup or town ofj3elaL City or Town: PermltAUcenx # Issaing Autbaity (circle one): I. Hoard of Health 2. BaIlding Department 3. Cltyliewn Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: Jun 0512 09:52a Lynn McIntyre 508-385-9407 p.4 UVI. •t. CVI[^ IV;:?LAt ENO.jyl4 Y. Z t. tvvu IY. c°�•• BC„1 � �IMPORTANT DOCUMENT - �:eT�IfSf,S12(:e E-f" TIAT10N ISsum BY Date of Shipment gyp. -.: ATION tiIUNBER - rnf��Re aetorvna EVANSVILLE, INDIANA 47M Tentidantiric2tian r121 t ° mANUFACTURERs OF THE rwisHED IU902�44 TEN1-PRODucirS oESCRlf9Eo HEREIN This Is to certify thatthe materials described have been flame-retardant treated (or are inherently noninflammable) land were supplied to: 76980 MNSTABLE COUNTY CORRECTIONAL 6000 SHERIFFS PLACE BOURNE MA02532 Certification Is hereby rnade that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAf 841 ULC 109. JOn719 aDal oo( Deseription of Item certified: rMTA TOP 201TX.10 wwm vp7Tt, Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The.Liiffe Of The Fabric )OWBOT[L STATFSV=NC Signed: EvERTsw,M,0N-AncwR li7LLswu puct tr - a OC29-CLE-9135-1-c d30e3 QLC=TT 90 bo ReR KC`aROT ''u 'IMPORTANT DOC WENT�'��'�'�' Certif leate of VlanZe Resistapee REGISTRATION ISSUED BY Date of Shipment APPLICATION an &2007 NUMBER s iHoiTs' EVANSVILLE. INDIANA 47725 Tent Identification FI2t.4 MANUFACTURERS OF THE FINISHED 04459i27 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: .70980 BARNSTABLE COUNTY CORRECTIONAL 600Q SHERIFF'S PLACE BOURNE MA 02532 Certification Is hereby made that: The articles described on this Certificate have been treated with a tlame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99. CPAI 84. ULC 109. Serial a 8002100(1) Description of Item certifled: FIESTA TOP 20WX40 WHITE VINYL viame metaranni Process usedl will Not Be Removed By Washing And Is Effective For The Life Of The Fabric JOHN HOYLE STATESVILLC NC Signed: it of Aepiicalor of Flom* Resistant rinish ANCHOR INDUSTRIES INC. Jun 0512 09:53a Lynn McIntyre 508-385-9407 p.6 •,run. 4. [vitorl :5imm— tic. J114 r. 4 IMPORTANT DOCUMENT Vra Flo �c y� Ceirtykate of Flame lgst stance ISSUED By Dale Shipmertt W 11�OEr 0 D7roT11 no R■giahaGonPIUTbCr CKGRO INDUSTRIE INC. TantlderSkerion F140.1 ru 14ST7630 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: BARNSTABLE COUNTY CORRECTIONAL FACILITY 6DOO SHERIFFS PLACE BOURNE, MA 02532 Certification is hereby made that: The articles described on this Cerlificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, CPAI 84. Serfal v elossas (f ) Description of item certired: CENTURY MATE EXPANDABLE END Z �C 40WX20 SNYDER WHITE VINYL % s r Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW PHILADELPHIA.OH Name of Applicator of Flame Resistant Finish '_� , Signed: AN HOR INDUSTRIES INC Jun 0512 09:54a Lynn McIntyre aJAA. y. LUIC••IU:i3HnNrovi-u:r. 508-385-9407 p.7 ...uM..,ti n. ;y 14 r. ) -- - . • IMPORTANT DOCUMENT • Certi tale of Flame &sistance ISSUED Dale /07110 tripment UED BY .� 0707ryD Regtatradan Nvenber f �i(kDUT� SSII N Tent IdentlficaC�on F140.1 14877530 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This Is to coMfy that the materials described have been flame-telMant treated (or are Inherently noninflammable) and were supplied to: BARNSTABLE COUNTY CORRECTIONAL FACILITY 6900 SHERIFF'S PLACE BOURNE, MA 02532 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-telardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, CPAI 84. serial 0 8108890C (1) DescrlpUon of Rem certified: /�,,� CENT MATE EXPEND 40X20 SNYDER A Q> 11419-L F- WHrTE WITH'BARNSTABLE• LOGO Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SN_YOER MFG N PHILADELP WOW Name of Applicator of Flamm Resistant Finish slsned: j�+� AN NC OR R44TRIHS INC Jun 0512 09:54a Lynn McIntyre 508-385-9407 p.8 0JU17. 9. 1UiLZIV:9Jh3U12-857-ttb41 Ftr"LK INN No. JYI9 f. CY vat rim • IMPORTANT DOCUMENT • ' Cemjlcate of Flume wistawe ISSUED BY Date of Shipment 07107110 Regi-3tration Number C F12110 INDUSTRIES INC. n® Tentdenrification t4asaa EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This Is to cerZiry that the materials described have been flame-reterdant treated for are inherently noninflammable) and were supplied to. BARNSTABLE COUNTY CORRECTIONAL FACILrTY GDOD SHER;FFS PLACE BOURNE, MA 02532 -- . Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, CPA184. Serial 8106402 t8I . Description or item certified: TENT WALL L&S2 610X22 WITH s' 5 2 CATHEDRAL WINDOW WALLS Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric TRIYANTAGE STATE SVILLE NC Name of Applicator or Flame Resistant Finish Slgned;J� AN HC OR 7NOUSTRies INC Jun 0512 09:47a Lynn McIntyre 508-385-9407 p.2 /V����� vtnouxunry Permit '/ " Fee S Permit u rtton from Gsm dare. EXPRESS BUILDING PERMIT APPLICATION. TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (503) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS:__rcE ASSESSOR'S INFORMATION: Map: S Parcel: ay, OWNER:-'/"r- 1-4 r;�r2r41L4�1��/ �jG.,:_ACLo F�1-7te N&%fE Ewr AMR _ e CONTRACTOR. LIW s-e 64iV (44 �. �'� �N �5 L4 .� /11ez fi`e NAME MAMN ADDRESS Residetttiat commercial 0 Est. Cost of Construction $ Home Improvement Contractor Lic.1 Construction Supervisor Lk. R Workman's Compensation Insurance: (check one) I am the homeowner I am the sale proprietor I have Worker's Compensation insurance Etts wce Company Name: Worker's Comp. Policy# e 5D6— 2.52— Zo 5 � WORK TORE PERFORMED Trnt(FireRccsrdantCartificzeattat:hed) ❑ Wood Store SW- 0 Siding: # orSqusces C Replacement windcmi: r C Replacerrcm doom. I ❑ Re -roof: t of Squares s) lmsulatiow () Stripping old shingles• () going Over_(ayta of existing roof ❑ . Old Kings MghwayMistorie District RoofmgfSldmg (Uke for Me) OThe debris will be disposed of at: Location of Facility I deckue under penalties of perjury that the statements heroin contained are true and correct to the best of my knowledge and belief. I tnderstand that any false answer(s) will be just cause for dea�ial/o,rr revocation of .try license and for presavdm under M.G.L Ou.268. Section 1. Applicant'sanwzc: 'yl ^'ILr7" LL�i L'c.r; cc -f • , + . SI t Brim Da on. Owners Slgsrarm (or attachment) Dale Approved Br• Date: Building Official (or design=) Zoning D(stsic Historical District: No Wares Resot= Ptourd mtm.cr YesY_ Rood Plain Zone Yes f Within 100 R. of Wafa�fr. Yes r/�� 3.91 Jun 0512 09:49a Lynn McIntyre 508385-9407 p.6 ti 1 ,4, The Commonwealth ofMassaehusem Department of IndW&WAcddents Office of Imwilgadons 600 Washington Street Bostor; RA 02111 www.mINA". Workers' Compensation Insurance Affidavit: Budder^iContractoritMectriciansfPlumbers Dlkstnt I•nfnrmaHnn Name (�ott�lndivi[hiat); C 2' .... ..,ao- zj - Pbone #• 5-6 a - Are you a■ employer? Check the appropriate box: --] f 1. ❑ I am a employer with 4. 0 I am a general contractor and I emploYeea (NU and/or part-time).' 2. ❑ 1 am a sole proprietor or parhm- ship and have no employees working for me in any capacity. [No workers' comp. k tmace rem] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required] t 3 a. 01 am a homeowner acting as a . general contractor (refer to #4) have hired the ors listed on the attached sheet. These s16-contractors have employees and have workers' COW. imurance.t 5. 0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152. 110). and we have no employees. [No workers' comp. insunu ... requirc l Type of project (regtdred): 6. ❑ New construction 7. 0 Remodeling g. ❑ Demolition 9. 0 Building addition 10.0 Electrical repairs er additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other ;Any applicant 11m checks box #I Olm also HII ors tbesecnon blow sbowina tbeirwmkcW r I Homeowma who mbmit this affidavit iadloti� they are doing all work and then hire poWi3nmtia tcamttac ' that ebmit this boat naut atnehad as addiconal than shown the ottsidt eotanacsta mast � n mAwk a taw atridavit indicating aoeb. employoea If the txb-ao mwtora have x mme of din ma and swhetbw or uat [boat Cnad s have �1 oYen, may mot Ruvide then wo*m. eocv- rwlio7 camber. I ear art+ employer that h provldtaa workers' CoMpenwdon Lnarance for my e a Informadom yea Below h diepolky and job slu Insurance Company Name: Policy # or Self -ins. Lie, Al. Expiration D ten Job Site Address: Attach a copy of the workers' eon Crty/Staterltp. Failure to stx the covers as peasstloo Policy declaration pate (showing the policy number and expiration date). p required under Section 25A of MGL a 152 can lead to the imposition ofcriminal penalties of a fine UP to 51.500.00 aad/orone-year imprisantncut; as well as civil pensltid in the tam ofa STOP WORK ORDER and a fine of tip to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invddgadons of the DIA for insurance coverage verification. • .•� ••"a�� carojy anatr roe paten danpendldn ofpedmry dFm Ae -- trsfornsatiow protdded abotre h tears and corrtci O,Biclai AN o* Do not wrW in thh arr% to be completed by cut' or tonne oj)lclal City or Town: PermltlLlunse 0 Issuing Authority (circle one): I. Board of Health 2. Bvgdfn Department 3. Cltyfrown Clerk 4. Electrical respecter S. Plumbing Inspector 6.Other Contact Person: Phone #• • • rfr7if3F1 L- _ - 1NfPORTANT DOCUMENT -- "'- ISSUED By [late of shipment - RSGLSTRATIOHtu:nm APPLICATION' ` NiIl1$EA Tart (dentiliotion EYANSYILLF, INQIANA 4TM oW2947 O MANUPACTUiiERS OFTHE FINISHED L;;D 41TENT PRODUCTS DESCRIBED HERON o This is to certify that the rnatmials described have been flagle-retardant treated (or are inherently noninilammabte) and were supplied to: 0 LO MXGM CHASE CANOPY COMPANY 4 NICKYS LN P O BOX 46 pAATiAPOISET E MA 27390406 Certilication is hereby made that: The articles described on this.Certiticate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPA] 84, ULC 109. F m Serial6, EZj44A4010Ct2)pescriplion oCENT ENn ww x:o LO fERFt 70z . J Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of. The Fabric � � Signed' �f • �y FLN n �TCY7u cc i e T���o-ate �" YA�E- ANCHOR INDUSTRIES INC- Name of ApMMIIicator'n! Fleme Resistmt Fnish rr�'c_FPrc� -. �3c1r2fc3P cPrlcr 0a 9 + . c IMPORTANT DOCUMENT' certificate of Vlairte hesistaxNe REGISTRATION ISSUED BY Oate of Shiptflertt APPLICATION I a usTI2007 NUMBER EVANSVILLE, INDIANA 47'725 Tent IdanfiTrcatiorl F44408 MANUFACTURERS OF THE FINISHED 033i]8d7 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been liame-retardant treated (or are inherently noniMlammable) and were supplied to: 266675 CHASE CANOPY COMPANY 4 NICKYS LN P O BOX 46 MATTAPOISEITE MA27390406 Certification is hereby made that: The articles described an this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. Alt fabric has been tested and passes NFPA 701.99, CPA] 84, ULC 109. Serial B 9144071)Ci6t Description of item certUled: Cl77 M10 40W X 20 FERR 70—J Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabri/c FMARI TFYTII F4 I A TOUR-M-PIN FRANfi - , Signed! Name of Ap licam►of Flame Resistam Finish i ANCHOR INDUSTRIESINC. . It I Jun 0512 09:48a w. w. coat Lynn McIntyre iV•GC 508-385-9407 p.5 nu. v.,cl vwc - 7 CHAae a OP V. AK ` EI R CERTIFICATE OF LIABILITY INSURANCE °" eirUM2 ' TRIG CERTIFICATE 18 ISSUED Al A MATTER OF IIIFORNATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T1416 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE: AFFORDED BY 114E POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT DETWEEN THE ISBUINO IN6t1RERt&), AUTHORIZED REPREBENTATNE OR PRODUCFR, AND THE CERTIFICATE HOMER. IMPORTANT: If the car0lkate haldgr Is an ADDITIONAL INSURED, the pabcypes) must lLo endareed. 115UBROOATION 13 WAIVED, subject to TLC tam and cendhlons Orthp Popcy, eenaln po"clas ovy requiresn andomemonl. Asmmemant on thla cor0ate don eon coMordghta to the oR7fleftholdertnlieu ofmxhoridomemon e. aRorryou:as BDp-824-670110 v147 I8irwiG ABancy 60ti 620.8g1 Franklin. MA42233 Daniel P. Buuhref► IF pa Bdi- o es, pAvotratol mrootpfw cowny live I 1111UREJUAl Paul Fire 6 Marine Ine. Co. nnuaq Chase CanepyCompany, Inc. OXnlal Cheea 4 Nlcky's Lane, P.O. Box 44 mattapoleett. MA 42730 Irsu ep :Tha Travelers Ineurenee Co. 1B03g URFM c: 11166AN o: omrp= a , s COVERAGES CERTIFICATE NUMBER: REVIBXON NUMBER: TMIs IS TO CERTIFY TINT THE PQLCXES OF INEURANCE USTEO BELOW MAVE BEEN ISSUED TO THE INSUREP NAMED ABOVE FOR THE POLICY PERIOD INDr—RTEO. NOTWITHSTANDING ANY REOLiRENENT. TERM OR CDNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMIJ TENS CERTIFICATE MAY BE ISSUED OR MAY PERTAK THE INSLOUNCE AFFORDED BY THE POLICIES DEaCRIBEP HEREIN IG SUBJECT TO ALL THE MIJB. EXCLLMONSAND CCNDMCNS DP SUCH pOLICIEE. LIMITS 6HOM MAY HAVE DEEM REDUCED BY PAID CLANS. IR Ym or alaumpice =0 =1 . POLCYISUMNA 4.11 VM LJYILa A ORNRWS UWLMY X =MMiRCJ1I,0EnERALIp,EILT MAN"AOE Q OCCLA cj100223Bea oB101n2 05MIrI3 EA04OCClARE14CL i 1,OD0.0 sy_ a 100, V E0 ERP AAOM a a B, KR80?tA'.LAWMUFV t 1.000. csNER.IAcoRsaAri i 2,0D0, DEWLAOMEMATEUY1TAPr'.IESKit pottey M 9FTlOC PROD.ICrs•L:auvAxA30 s 1,OD0,00 : B ALITDLoelu UILaLn. AWArD x rLFn U80 AC AT0O X FWF-0AllfOi ALIT06 8A8242XI07 - ONIM2 0501n ! ; 1000.00 I 60D00}LYYI.Anl1AYDlP�Ia&LLmeoC B eF 3 i A agRaAAUAa uFN.Rw. AE CIoeeJUuYRSyADE LODIDIB04 BS101112 03101/13 EACH000URR:NCE s 1AD000 A=REOATE / 1A00,00 IDEDIXIF/ �OOOD A wouiRa c0YR9AAn01 AND RVRaym U40UTV IIjj11 ANRPRO eARTriiUE1ECIrA n (worm"I1 II m1111Li1 Agr / b,.I PA NU93124T93T12 I DIMII12 01101113 1 x L.EAC REDDEN A 100,00 I.LpSGA]C.FA EVRDTE E InDD E.1.C,6EAIIE.POLICTMT I fi00a10 A rulpmomfflalbor IND02P1i89 05N7J12 06101113 LIrtNt 1.110.000 Dad. - sw p Hwy w�R FaWgc E t'n'et MILDeATIOrerWA"LU (Autn ACORP Ill. AOAELm,a Runwt.SMww..Rma.Ipnaul.wr.q - TAYLORP 6HOUL.0 ANYOF THE ABOVE CCBORIND POLICKO BE CANC6L1E0 DEPORT THE ETIPIRATION OATS THORMIF, NOTICE VA).0 BE DBLI AGO N Taylor Preurvetlon Aeeos. ACCORDANCB+MITH THE POMDYPR�61ON6. Shoop BhssrlRU Benefit AlnAoraxeaperaiwnrrve 108 Bray Farm 1 North Vormouttlport. MA 07076 F 01016-MO ACORD CORPORATION. AN fIaM4 reaerrad. ACORO 2512010=1 Tho ACORD name and logo oro reglctored make of ACORO Jun 0512 09:47a Lynn McIntyre 508-385-9407 P.1 Taylor -Bray Farm Preservation Association 108 Bray Farm Road North - P. O. Box 66 Yarmouth Port, MA 02675 Phone and Fax: 508-385-9407 FAX TRANSMISSION COVER SHEET Date: June S. 2012 To: Town of Yarmouth —Building Dept. Fax. 508-398-0836 Re: Tent permit for Taylor -Bray Farm —110 Annual Sheep Fest. Chase Canopy, Mattapoisett, MA You should receive 6 pages, Including dds covcrsljeeL Ifjou do not receive all oftlte pages, please call (508)385-9,107. Chase Canopy slid not send me the Workman's Comp. Certificate, I have requested them to fax that to you directly. 03-28-12;08:12AM; ;5087717998 # 1/ 3 7"O«"N OF VARY ourtl BUILDING DE;PARTMEY7 1146 Route 2S..Nouth Vartuuuth. \1.1 02664 5118-398-2231 ett. 261 Fax 5 08-398.11836 Permit Number iZ-lZ o�s Date Issued Expiration Date TRENCH PERMIT Pursuant to C-L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PEIMIT 11UST BE FULLY COMPLETED PRIOR To CONSIDERATION 4a^eOf'1pp1ka^t Town of Yarmouth Water Dept. Street Addrm 99 Buck Island Road Cityrrow" West Yarmouth I HA ZIP 02673 Name of Excavator (irdiffereat from applicant) Street Addrm Town of Yarmouth Water Dept. 99 Buck 'Island Road West Yarmouth Name of MA 0,L673 -------�•-'a/a7�- iF Tam Street Address /4r ora v Zrix- Jew m rfG Cltyfrown %11%ZIT �iltauf-�per� �1I O.z(.7.� 508-771-7921 - 508-771-7921 one CCU Ueseriptio^. location and o! ry trench:- r Please describe the exact loce6on of the proposed mieh and ib be laid In proposed trench (el: pipedcable lines.et`) Please use revPurpose et�'d(includef addict ona! pace lIsneeded what is (� is intended) to c���e�7CGl ���� .�P�CvrCe r.c�v/crec�7ei,� ma".w Ad 4,11'm I s /airy Insurance (•ertitkate v: Town of Yarmouth - self insured Name and ('onuet Lnfntmatton of Insurer. �------..� Pam Barnes - 508-398-2231 ext.:1270 Digs Namr impetent Person (as termed by C:-N1R 1 of2 03-28-12;08:12AM; ;5087717998 # 2/ 3 t SERVICE NO. as NAME • 1 6- c.rcxa k1 srR�=_r V O d Q r ! .* F G,e rrti a j -Nib, A4o2 5C VILLAGE l A .. MA4- METER NO.'O3 I D OS I ,3D J c>l 0 DO a tl Yl�glD2 dL m62r 33'-;L 3er 9/X.//e/ • Id / �cvN �rar•• �e/tJ J cv - 03-28-12;08:12AM; ;5087717998 3/ 3 SERVICE NO: r •' :� •/• LL '' NAME v -Tr-�.. F..i` - . --nWn ofi' �A/Cmoc�}h 5TREEr 1, 8: Bray Farm Roecl• -(md house) Le + — VILLAGE Yarmouth., Mass. METER NO p,- f TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1263 Fax: 508-398-0836 K. Elliott, Inspector of Wires kelliott@varmouth.ma.us September 27, 2011 Stephen Chouinard Mello Electric Co. Inc. 138 Morgan Street, Fall River, MA 02721 VIA: CERTIFIED MAIL WITH RETURN RECEIPT RE: Bray Farm,108 Bray Farm Road, North. Dear Stephen; On September 26, 20111 visited the job site to perform a rough wiring inspection of the wiring. At this time I can not approve the wiring as installed to this point. The reasons are as follows: Article 210-70 (A)(2)(B) Egress Illumination (Also found in 2009 International Building Code Section 1006) Article 760-24 Fire alarm cable subject to physical damage Article 760-53(A)(2) Fire alarm cable passing through floor or wall. Please make the necessary corrections and advise when the job will be ready for the re - inspection. If you have any further questions please do not hesitate to contact me. Sincerely; Town of Yarmouth, Building Department K. Elliott, Inspector of wires CC: Jim Brandolini, Building Commissioner Karen Greene, Community Development Dick Court, Clerk -of -the -Works r TOWN OF YARMOUTH Building Department BUILDING - - - - - - .. , (508) 398-2231 ext.1261 PERMIT NO - 8-1(-1513- PERMIT ---=- ISSUE DATE •6l612011. • ; PROPOSED USE APPLICANT Chase Canopy - - - - - - - - - - - ---- - - JOB WEATHER CARD PERMITTO I iscdtent ; I AT (LOCATION) 0108BRAY FARM RD NORTH ZONING DISTRICTR-40 Bldg. Type: Commerdal I SUBDIVISION MAP LOT BLOCK 151.24.1 LOT SIZE erect temporary tent - duration: 08/10/11- 06113111 REMARKS AREA (SO FT) EST COST (S 50.1 OWNER OWN OF YARMOUTH ADDRESS 0108 BRAY FARM RD NORTH [Yarmouth Port I MA 102875 BUILDING IS TO BE: CONST TYPEI I USE GROUP FEE ($) 50.00 BUILDING DEPT BY PHONE CONTRACTOR LICENSE 0 Chase CanopyCompany 4 Nicky's Lane Mattapolsett MA 02739 8006492055 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLLIC WORKS. THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OFANYAPPUCABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBINGIGAS AND MEMBERS (READY FOR LATH OR FINISH REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. COVERING) 3) FINAL INSPECTION BEFORE OCCUPIED UNTIL FINAL INSPECTION HAS , OCCUPANCY 4) REFER TO DETAILED INSPECTION BEEN MADE - SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE TOWN OF YARMOUTH Building Department BUILDING _ .. _ ..... , (508) 398-2231 ext.1261 PERMIT NO B-11.1513. PERMIT ISSUE DATE ; _ _616/2011_ _ ; PROPOSED USE : .. _ _ _ _ _ _ APPLICANT Chase Canopy - - - - - - - - - - - - - - - - - - -, JOB WEATHER CARD PERMITTO MlscJtent IAT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICTEO Bldg. Type: Commerdat I SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: CONST TYPE USE GROUP LOT SIZE erect temporary tent - duration: 06110111 - 06113111 REMARKS AREA (SQ FT) EST COST ($ $O.i OWNER OWN OF YARMOUTH ADDRESS 10108 BRAY FARM RD NORTH PERMIT FEE ($) BUILDING DEPT BY PHONE YOUR SPECIAL ATTENTION Is called to the following: CONTRACTOR LICENSE 0 Chase Canopycompany 4 Nickys Lane Mattapolsett MA 02739 8006492055 This permit is granted on the express condition that the said construction shall, In all respects, conform to the Ordinances of this jurisdiction Including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit Is Issued must be displayed on premises. The Department must be notified and inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing bulldings require a minimum of three called Inspection, namely,1) Footings, drain file systems, foundation and basement wails, when walls are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanical systems are Installed. 3) Final Inspection when building or structure is completed. On jobs Involving reinforced concrete work, Inspection must be made after steel Is in place and before concrete is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been Inspected and approved by the Department in accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee Is also charged predicated on the extent of the variation from the original plans. Permits are not valid If construction work Is not started within six months from date permit Is Issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been Installed. Painting or decorating Is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY FFS d Jun 0111 08:46a Lynn McIntyre 508385-9407 p.2 lt)Inoc use voh' $ PrYmdt .cpicea ti months ismedate. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOL TM Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508/)398-2231 EXL 1261/ ` if CoxmUenON ADDRESS: ASSESSOR'S INFORMATION: ovNIM: -jLqLln cC' l NAME CONTRACIO • J4 -e �,N%Qlllo Residential Map: 5 Parcel: Commercial Fat. Cost of Comststtction S Horne Improvementis Contractor Lie. Consuucrion Supervisor Lic. tl Worknurt'sCompensationlnatmnco: (clieck(oe) I am the borneowner I am the sole proprietor haw Worker's Compensation Insarance Insurance Company Name: Worker's CcnV. Policy! if WORK TO BE PERFORIM Tend (rjre Retardant Catlfrcxd inn L&, jr '�Z 0 tDiA!Pl i Wood a..a Sb-� Siding: 0 of ment teindows: 0 Repheanent doors: Replace 0 Rc�rooL• 0 of Sgmrcs .- () Suipping old shingles' () gig over Iayen of existing roof v Old King, Midway/Historic District Roofing-rSidcng (Like for Lice) wnw debris will tic disposed of a: Location of Facility./ I declare under penaltks of po jury that the steements herein contained are true and correct to the best of my lmowt*e aid belid: I uMastand that any Wt wswa(s)- Wei be jud cane for or revocation my license and for proravtion under KUL Ch. 268. Section 1. Applicant's S[goatur' r" Dace Da Owners Signature (cc atncli Data Approved try --'— pmimiee OrfwW for destine) Zoning District Mgmical District NA No flood Plain Zone: Yes No Water Resource Protection District: Within 100 (L of Wetlands: Yes No Yes No 3)01 Jun 0111 08:46a Lynn McIntyre 508-385-9407 p.3 05/1t3�2611. V3:39 F. ne t CERTIFICATE OF LIABILITY INSURANCE THltt CERTIFICATE 15 M5MD Aq A MATTER OF INFORe MN ONLY AND CONFERS NO WQKM UPON THE rMMCATF HOLDER. THIS CERTIFICATE DOER NOT APFIRMAIT111LY OR NEOATNELY MEND. EIITEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CP.RTIFICATI; OF INSURANCE DOES NOT CONSTIMIE A CONTRACT WHEN Trig 13ALIN0 0N8UREIII81, AUTHORIZED KEY VENTATIVEORPRODUCEPIL AND TtECERTIFICATE HOWER. IMPORTANT: If 1111 C6rjk;dlo holder le sR AOORIONAL MBURED, Tlto POtleyElesl f1a1q IFS enderssd. I OUBROGATION 18 WAIVED. Sus to to the Wvmv and CUMOM at the pol�Clr• Carole P000Us Insy Isgnke an 6ndarverro t A SWOR enl On Data csrUticeM NM not wtlfay tlehls to 1fle Ap"Cy Dental Chne 4 Nleto Lens. P.O. Box 45 MElpapaIpt4 IAA 02738 r, tlri-T:.a COVERAGES C TIFMATETItRentcH: — - THIS TO CERTIFY THAT THE POLWAFS OF INSURANCE LISTED IELOYV PAVE BEEN IS6UE0 TO TFtF 1p ER a FWIEO ABOVE FOR THE POLICY PERIOD LL WDJCATED. NOTWWTANMNM ANT Rf OU6IEYENY, TERANY CONTRACT OF CONOMoN Of ACONTRACT OR �� OOCIIMEIA METH RESPECT TO W111CK TIilS CEFITIFICATE MAY eE IB6Ut OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE P000196 DESCRIBED nniN ES SUBJECT TO ALL THE TEJIM6. EXCLUSIOIISANDCONOITWHSOPSUC POLIGE6.UMTSbtjOYHNAYFIAVEBEENRE0UCE0eYPAlOCll1t46. TIM 41[/11 wxe ■ linin1 - - 0U21H1 LAIRS Omni . R8N21N12 EACH OCCJORfNC! { 1.ODD.0 WIL OERlRAL LASRLITT B X GA[A3.iADE X� Dew LNM POM82ATE uwr APCII[a PER: POKY _ A MNDIII ALIAPLM A MYAUW ALLOANEO AUIOS X T0jl1LE0ALt1W X wIEDAuros X HONrnu¢o AtIT06 _ TEII s 100.0 CK SIEOEAP eft um t LOCI PER60NAL► ADOI"My a T,QD000 oENlRALAeoRlcAT! [ YA00 00 P13001ICIS •CdFiOPAIA S 1AQ0.0 COU�lE9i11�lLYn �s,yr,r„I [ I 1000,0 eOpatl piARYRIrMnsq 1 eODLY atAJRTffM[rpIM1 6 PROPER1YMVA31 p[rRmatl1l t t S A X LWIBULAws emuua txcw cLUFIs+AAo[ I 0E101ni Omni [ACHoccuRRta+cE [ 1.000A AO�t�re 1,00000 i X 76oJCAti1E o 10,000 B waRROI[ COAIFeruna+ AEO EeFLOTtRf LMeIFflY YI 'ow°PiI�[v°RRPAFExci+mEuTNc� IYWIOgM Al wmrcROG22n6v� VIA NUA,ITB1711 81AUI1 011016T2 x .LEACHA000M 100.011 1C0,0ulOsl[nt RIMMIII-eAZIPPLUMMS o.as �1� 71�1����i 701106156E Np fat (i��l, EVdM 8177t11 Et1O 7 E�a[�Cnm. r ww ryAw w n W..q TAYLORP @MOULD ANT oP THE ABDVE MCFk = PDLCWA OE CAN=LtP BEFORE THE CXPMATX* DATE THEREOF. NOTICE yfiLL 09 CXL1V=0 IN Taylor PrReerretlon Afsoc. ACCOROANCE WITH THE POLICY PRAM ONE. I n gray FarIR r■nnouthpoR, MA 02e18 AUrHopntaSE►RSSEiYTATN! 2 ... =4.:+A&"A&4, ACORD 2112002tOel The ACORD ronLo and logo era teBleteAd marks of ACORD i !�J"}IZ ".�I•U'ir'i�'B1i'J71?J rJr'J IMPORTANT SON Res w � 1 miSTi ,noN APPUCOLMON ssuta BY NUMBER F14ti EVANSVILLF., INDIANA 4772S MANUFACTURERS OFTHE FINMHED Data of immufacture '1 IEN I PRODUCTS DESCRMED HEREIN This is to certify that the materials described two been flame-retardant treated (or are inherently noninflammable) and were supplied to: 2WVS CHASE CANOPY COMPANY 4 NICKYS 1N P O BOX 48 MATTAPOISETTE MA DM9NDS Certification is hereby made that: The articles described on this Certificate have beert treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code, equal to ettceeds NFPA 701, CPA184, ULC 109. _..�- P71 ;a. a no metnon DT mC Tn Serial a S=0) thscr4wan of item ae&6.W4OWx2DmSNWIRV W Flame Retardant Process used ulna rMua o= "W■,a%Vss�� - X Washing And Is Effective ForThe Life OiThe Fabric .AHM= RWSTMES NC. CL C m 9. IOD m 00 IP.- tl RT 2?i1JR'P'f•JPJPJ?7h�13JrJ7Jl�( elzt 1 . • ' i�IRJfJ ii-e17J 2��J2ri REGISTRATION APPI.N ISSUED 8Y s NUMBER EVANSVILLE, IN01A'NA 47725 F1d0.i MANUFACTURERS OFTHE FINISHED Deft of uenufactum TENT PRODUCTS t}ESCR[BED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 25WS CHASE CANOPY COMPANY 4 NICKYS LN PO BOX48 MATTAPOISETTE MA OM9MG Certification is hereby made that: The articles described on this Cert111cate have been treated with a flame-retardant approved Chemical and that the application of said chemical was done in conformance with Callfomla Fire Marshal Code, equal to exceeds NFPA 701, CPAI 94, ULC 109. 1fh-Mftthnr1 nt thw PR chemical anniication is: SWIM ff 8t]0200{lI Description of item eeHcQrr Je m tow x as t10 smnot ww Flame Retardant Process usea will Noi.we nemoveo vy Washing And is Effective ForThe Life Of The Fabric rm KM reaiADE-THILM signed: of Ffarrme UEPARnum - ANCHOR RMS1RIE5 r m .-............--- . C REGI.4TERM APPUCMDN HUNUER IMPORTANT DOCUMENT L x� of flame ay EVANSVIU.i. INDUWA 47711 F1�01 MANUFACTURERS OF7HE fINISHED TENT PROI]UCTB DESCRI9ED HB;DN This is to certiEY that rc the materials d 1[edd have for alnhoMdIY nonirrllmn�1e) and waste s+Ip 266575 CHASE CANOPY COMPANY 4 mcKrs LANE Q O BOX 46 MA7TAPOISETM MAD27390408 oesit$tanve EDsts d tlamrh�+n t12Acs►e0 Oidw NuMb.r 7 310M been flame-retardant treated Tc yoiravM �'�'�. Cortitieation Is hereby made that:: vr" a t,ame.retardant approved The articles described on this Ceririftcale have been treated chemical and that the aplpi�e Nof FPA 701CCP�►1 8ca41, Ul.0 was 109. In•+i;onbl�nanax with Calitorrtla Fire Marshal Coda, egtw to The method at the FR Chemical application 1w. C. 9130100(2) Description oI Rem certiilat Cwr Uim MoP 7C?D VL W'W Flame Retardant Process Used Will Not Be Removed By Washing And Is Eiiective For The Life Of The MAC spa .J � TENT pEpp lENi—M7- M MOUsMIES INC. --O a estsouu FlrJ i rn 0 03 top 03 0 V w Jun 01 1108:50a Lynn McIntyre 508-385-9407 P.1 Taylor -Bray Farm Preservation Association 108 Bray Farm Road North - P. O. Box 66 Yarmouth Port, MA 02675 Phone and Fax: 508-385-9407 FAX TRANSMISSION COVER SHEET Date: To: Fax. _60 Re:ertf� e�,urfrY15 L�f:�, S���rt'Spf You should frcrrcr _Imo, tncludingthis cotrrshcct- if}emu do not mriva all of the pnvs, plcasc call 43'08)3&rN07. Jun 01 1108:50a Lynn McIntyre 508-385-9407 p.2 rxrree Use Umy Ptsmh f ras pen dt espires 6 mori s from issue dare. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 Map: I Parcel: OWNER• tV CV/1 NAMtr ERES11171' CONTRACTOR: tV f—a,5-1 & l_dyn] Residential Corrraercial I TEL # I TEJJ/ Est Cost of Construction S Horoo Tmprovement Conttacw tic. # Construction Supervisor Lie. # Workmen's Coatpenstttion k[surmice: (check one) no Wb/CIE �G'2?irQ s re I tun the homeowner I athe sole proprietor 1 have Worker's ConTeaysation Insurance Insurance Company Name Wodwes Comp. Pollcy# WORK TO BE PERFORMED ent Ued)ire Retudant Certificate attad+r , Jr ! !✓ ✓Cie r i Wood Stotr Shad Siding: #ofSgtares . Replxemeotwindows* 0 Replacnsrat doors: s RrrooP #ofSquires _ () Stripping old 9&glcs• ( )going owes tay rs of etisting root _. Old Kings Higiwayffstoric District Ranting/Sidint pike for U10 wThe debris will bedipua:d otnt tllcatirm of Facility I declare under prnsitles of perjury that Ere statenvmv herein conmind are true and correct to the ben of my knowledge and belie[. 1 ondermad that any Wse aaswer(s) will be jtni case for d nfW or avocation of my license an/dyfor prosecution under MJML Ch. 268, Section I. AppliymIsSigyzurt: x yl�lt� Gt�L/ L/1� Ontc__%1Li'IC�CA �l o mars Signature AWWTW 0Y Date: t)edtdiag0[fuckl (tr designee) Zoning Distriet FLstorkA District Yes No Flood Plain Zone: Yes No Water Resource Prrorection District Within 100 (I. of Wetlands: Yes No Yes No 3m1 Jun 0111 08:51a Lynn McIntyre 508-385-9407 p.3 May. 27. 2C11 3:21]'M IMPORTANT DOCUMENT M 7rkj Cer afwate of (Ana 9ZFsistance �0 -4 A10 ISSUED BY Dale of st,tvn+em _W r{ 1-0& 0CHOovomo Repist atim Number I fr1pUsTRt1=i�'o Tent Identification F140.1 �� 14877630 EVANMLLE, INDIANA 477ZS MANUFACTURERS of THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This ►s to certify that the materials described have been flame-retardant treated (or ere inherently nwinflammetrle) and were supplied to: BARNSTABLE COUNTY CORRECTIONAL FACILITY 500D SHERIFFS PLACE BOUKHE, MA 02532 Certificabion is hereby made that; The articles described on this Certificate have been treated wkh a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, CPA] 84. Serlal # e108w5 (1) Description of Item certified; CENTURY MATE EXPANDABLE END 40WX20 SNYDER WHITE VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric =SNYDER MPG NEW PHILADE MA_0H Name of AppEcator of Flame Resiatani Finish Signed: ANCHOR tJr 4TKIE3 INC Jun 0111 08:51a Linn MolntYre _ _ 508-385-9407 ., _ _ p.4 IMPORTANT DOCUMENT e'en ate o, f 17&w 2psistance ISSUED BY Date or Shipment ,.., tnmm o Registration Number IR #9 Tent Identif Orlon F140.1 IMU10111r-� 14877530 EVAtsSVILlE, INDIANA 4725 MANUFACTURERS OF THE FINISHED TENT PROD UCTH DESCRIBED HEREIN Tttls L9 to CeMfy that the mate -IBIS des=rlbed have been tlarne-retardanl wasted (or are Inherently noninflammable) and were supplied to: BARNSTABLE COUNTY CORRECTIONAL. FACIL17Y 6000 SHERIFFS PLACE BOURNE, MA 02532 Certification is hereby made that: The articles described on this Certificate. have been treated with a flame-retardant approved chemical and that the application of sold chemical was done In conformance with Califomla Fire Marshall Code. All fabric has been tested and passes NFPA 701. CPAI 84. Serial 0 WWII= (1) De3cription of item certified: CENT MATE M(P END 40X20 SNYDER WHrTE WrTH'BARNSTABLE" LOGO! Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW PHII &MEHIA.OH Name of Applicator of Flame Reelstard Finish Signed: �0�/i'/ AN HC OR INOtIS ws IKC Jun 0111 08:52a Lynn McIntyre 508-385-9407 p.5 fi�AY.21. 2011.2 3:211`012 86/-m r IMPORTANT DOCUMENT Certificate ofg7&1ne RpsisUnce Date ofshipmcni ISSUED BY 0707110 RegistmUDn Number F-t2t10 Tent Iden86cafmn 1487T530 EVANSVIU.E, INDIANA 4T725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to cerVy that the materials descried have been flame-retardant tvated (or are inherently noninflamrtisbkl and were supplied to: BARNSTABLE COUNTY CORRECTIONAL FACILITY 6000 SHERIFFS PLACE BOURNE, MA 02532 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done In conformance with CaCtfornia Fire Marshall Cade. All fabric has been tested and passes NFPA 701, CPAI 84. Serial e 810"02 (8) Description of Rem certified: TENT WALL L682 6'10XZ2 WITH 2 CATHEDRAL WINDOW WALLS Flame Retardant Process Used Will Not Be Removed By Washing And is Effective For The Life Of The Fabric 7RNAHTAGE STATEMOLLENC Narti9 of ApprlWtor of Flame Resistant Finish si0ned: �I�J� AK HC 0R N[DUSTRIES MC Jun 01 1108:41a Lynn McIntyre 508385-9407 p.2 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 509-398-2231 exL 1261 COMMUNITY EVENT SIGN APPLICATION Application is hereby made to Install a Community Event Sign, in accordance with MIGL Sect 8, Chap. 85, and Town of Yarmouth Zoning Bylaw Section 303.4.1.1 (except for maximum duration), and the Selectmen's Community Event Sign Policy. An application may be submitted by religious, civic and non-proi'd organizations. Construction and installation of signs shall be the sole responsibility of the applicant. Signs must be approved by the Yarmouth Building Department The locations must also be approved by the Yarmouth Department of Public Works. Signs an town land must be approved by the Town AdminlWator. Signs an private land must be approved by the property owner. There is no fee for Community Event Signs. This application shall be accompanied by a diagram showing the design. di r+enslons, colors, and proposed location for the alga. Additional regulations: The size of signs Is limited to thirty-two (32) square feet H the sign is double-faced, only one side mein be counted for measurement Signs installed and permitted under this policy may be installed for up to 12 months duration, or until the advertised event or campaign is completed, whichever comes first Renewals may be applied for through the Building Department The content of signs must be non -political and for a non-profit organization. Internal Illumination. moving parts. or the appearance of moving parts Is prohibited. The applicants agree to abide by the terms of these laws and regulations. Community Event sign permits may be revoked at any time for any infraction of these laws and regulations. 6r-15 ?, � i► t Y?zS• i'TS`�C�� . PermkR APPLICANT: �Gt.c f� ACC SIGN LOCAl101k�O�►lEi �fi GA CONTACT PERSON: I—if►ii4414�l �z jre- _L PHONE: MAIL ADDRESS: t' 6, bc-x & Cn CjQ iyl t6U��L/''�/ EMAIL: ile- r lr lif INSTALLATION & REMOVAL DATES: 'V cco'w-w r- iZ, Zo 11 A .!e _ SIGNATURE OF CONTACT/AUTHORIZED AGENT: Please Note: The Building DeperUnent shalt bs notified within tan (10) days of any change in the above trrformstlon. APPLICATION APPROVED BY: Date Andrew L Amauft, Building/Sign Inspector APPLICATION APPROVED BY: for Departrent of Pubic Works Date APPLICATION APPROVED BY: Date for Town of Yarmouth (or) Property Owner PLEASE NOTE THE FOLLOWING CONDITIONS: APPLICANT ov r TOWN OF YARMOUTH Building Department BUILDING - , _ , (508) 398-2231 ext.261 PERMIT NO B-10 414 , --- � ISSUE DATE :_ 10/2/2009 _ : PROPOSED USE ;_ _ _ :. . _ PERMIT APPLICANT RicherdCouri ""' : JOB WEATHER CARD ------------ PERMIT TO Demdish AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT® Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 15124.1 BUILDING IS TO BE: CONST TYPE 5-8 USE GROUP R.9 LOT SIZE irderior demolition REMARKS AREA (SO FT) EST COST ($) $3,500.00 PERMIT FEE ($) OWNER OWNOFYARMOUTH BUILDING DEPT BY ADDRESS 11146Routa28 South Yamiouth MA 02664 INSPECTION RECORD Date Note Progress - Corrections and Remark CONTRACTOR LICENSE Court Richard 158 Indian Trail Demisport MA 02639 5082942415 PHONE 5083982231 FIELD COPY r 9 oft, Use Permit No Permit Fee S Deposk Recd. $ Net Due 1.1 BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE. CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.. Town (tf l'irtttottth Building Department 1146 Route _tR . 1'annotith. ,IIA 02titi-I-.1-192 Tel: 508-398-2231 ext 1261 Fait 508-398-0836 ' P mft Board infornwon 0.ssesson Deparhnem Irdortrtatloa _ ata( type MAP Lot ndorufff t Dale f RetordkV Oat@ e Platt No 1.4 frroperty Dimenslonx New other __ — - lot Fro�Mage (ft� Lot Covrnpe 1a teo MMS setbacks tttl Front Yard CertiAcate of Occupenty Dais h b not required Side 1.2 Zoning k*ffnaeon: Zoning District Proposed Use 3.2 Registered Home Improvement Contractor. t Not App&:eble Expiatlon "= Telephone signature nsation Insurance Affidavit (M.(3•L c- 152 3 25C (f!1 c.mvn Section 4 Workers Com application. Fa Work Its Compensation Insurance affidavit must be completed and submitted with this app ll result in the denial of the issuance of the building permit. to provide this affidavit wi Signed Affidavit Attached Yes .......... Section 5 -Professional Design and Construction Service s -'"ford S 1 toffee�ub� space) to Construction Control Pursuant to 780 CMR 118 (containing more than Section 5.1 R Iste d, Architect: Not Applkabto ❑ — q�gpn Number Expiration Date Telephone Signature nne gayuraiioe NurrAW idress E mk~ Dan TV of PaaP Name paglatraeon Number Address Expiration Den Telephone Signature Ane of Ftasponsbiei Name Reyetreoon Nutree Address Expiration pare Telephone Signature . Ana of POSPcnsO Name Registration Numbs Address _ Expiration Date os..nn Not APPficable r� Address Telephone Signature 2of 4 J ectlon 9 - Description '•' ptlon of sect Work (ril.dc as app�cable) •. New Construction Igor mumpN hn,pp o�hl No of Bedroone par mumple dmYy Ohl N0. of Bathrooms Ens" � ❑ Re 993) ❑ AReratbris -Addition Q _ Accessory Bldg. O Type emoattan Other Spedfr 800 Dwriptlon of Proposed Wadc I _ i asesE�s - A ASS A KY Bulk" use ❑ In summse E EDUCATIONAL F FACTOW. D N HIGH MAZAIIO ❑ 1 INGTRUTxxft D Aa MUCK4 mss ID n RCSKW TlAL D 7 u STMAGs UTKnv lE3 ❑ D M Lmm um SPOCALUSE I rl E, -+o Uee cLcw Ll Ed8*ro N.:ard.. Aso clw s• Secaon a B ulacky FIe19II11 an OW" Are N F*wdbwaerabdae webda Ow�nwa ""a FbwAm pw Fbw pq Told Am AN Floats (sl) Total Newt Ifn coup (Grow es appfeapable) Canebucdm Type A-1 D A -a D A4 D IA D A4 C3 M 1■ D 7A ❑ b ❑ F•1 Fa 2c 34 ❑ FI 1 J 1-3 171 at D 4 D . IFt C31 I R-a n 54 D 3-1 srEc�,r: SPEC r sa s. povoaed use eLouoe --- I t�lepoa.e Netenl Arldee Leo clan � I PICOOMd I I 1 %JwGvm v - 01 nw 1 UNux PEER REVIEW IMIC IR 1101111 I Inar�.�.s..r •�.w...r a __ �_ ter. y.ww-y a.vc�a►wl narfla'FNp//N Y SECTION 1 an OWNER AUTHORIZATION - TO BE COUPLETEO WREN OWNER'S AGENT OR CONTRACTOR APPUES FOR BUILDING PEANT as Owner of the subject propertyt hereby authorize FYI /I c to ad on :vylbZ,01. in a*matters relauw work uthorized by this buil ft perm*appacattoaalur e1 Gan d OVER �. • i . - . • .Lill iMANOR Chgak Below 0c4mwmmmxwmmkdm FMV (I wpkd") Coean . appow (it appIcable) 4014 The Commonwealth ofMassaehusetts Department of Industrial Accidents Office oflnvestigations 600 Washington street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers olle ant Tnfnr.na►r.... Name Address: "•' ....a.u�, r /V/ CJ Phone #: Are you an employer? Checkhe appropriate box: 1. ❑ I am a employer with 4. QI am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees working for me in any capacity. [No workers' comp. insurance required:] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t 3a. ❑ I am a homeowner acting as a general contractor (refer to #4) These sub -contractors have employees and have workers' comp. insurance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4). and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. Demolition 9. Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other •Any applicant that cheeks box #1 num also fill out the section below showingttuQ I wockcers' eompeavaad policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors rust submit a new affidavit indicating such. tContnctoa that check this box must attached an additional shed showing the tame of the subtomaeton and atata whether or nod those entities have employees. If the sub -contactors have employees, they must provide their workers' Comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below Is the policy and Job site lnformadon. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal ties of a fine up to S1,5o0.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby and C OQ7e141 use only. Do not write in this area, to be completed by city or town oJJlclal Is true and corms City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person• Phone #: Information and Instructions Mssaachuseds General Lawn chapter 152 tegtnites all empbytm to proride workers' Compensation for their empbyta. Is defined as »every Palm in thee of another under any contract of hire. Pursuant to this statute, as iarDliye�r . express or implied, oral or written-". ;s defined as "m individual, p=Mash* sssocnagM corpoatnas or other legal eadty, or any two or mere f this torevhK enpLW in a� �' sad hxiudiai td o legal repof a deceased emploM a the recciva at ttasice of an W Mdtt L partnersWassociation or other legal entity, employing employees• However the owner of a dwelling homer having not more this° three *wt meab and who resides therein. at this occupant of this dwelling bome of another who eaploya Persons to do mdntcu n construction or repair wrack on such dwelling house or on the pounds of building appuatensat thereto Shan not beano of sock empbymeat be deemed tobe an empbW MGL chspeer 1329 f25G6) an states that "every stab er heal'eemlag agesey sia= widawd this taassea K renewal of a Ueenm err pwmh teoperate m bsds err to eemtrnet bdldbga is tits astm stwaltit fen asy appnewd who ban net prodnnd own$" evldesee of ampUana with the Imsrara average regds'si" AdditbosUy, MOL chapter 1529 f 2XM scats "Neither this eommonwesltb'nor veay of its political sttbdivisions Cofer into any conhad for the pamft—M es of publb wodr until acceptable evidence of complimm w ith the insurimm requirements of this cbq*w have been prod tothe coabwft authority." MONO Appliaar , Plesm fill out the workers' coapea»dw affidavit completely, by checking the bona that apply to your situation ad, if necaserl, supply mnn'(')' addres cs) and pboe a number(s) along with their certificate(s) of insurance. Limited LiaMUty Cow (LLC) or Limited Liability Partnerships (LIP) with no emPloyea other tine the rnembaa at partners, we not requh to carq wo.im , compensation hmance. If an LLC or LLP does bare employees, a policy is rimrequiso d. Be advWAcov that sgL � q =it M a date this amdaviL The affidavit should ed to the Department of Industrial Aaoideab !ter dw CU ratios of kaurance coral = for this or license is bafng requested, net the Deparenew of jn ua&W d c the city err tower bm �xPPHthe � ne if you ne mpdred to obtains wake ' Ian Aecidetm. Should cpolicy, Plans tern the Department at the number listed below. 3dUnsrsed companies should enter their ompenadoa -�� • --- rant.. eumbsr a the appropeiate lice. Clty or Taws Ometab Pleass be sure that this affidavit is complete and printed legibly. The Department has Provided a space at the bottom of the affidavit far yen to fin oat in the event tha of5m of hmcsdpdow has tocontact you the applicza plea nine to fin is tl>t�pa,,m, t�yylia.�nee mrmber which win be used as a reference a mnba: Ice ad 6016 as applicant that anal submit mnhipb P9 """ c"M applies k my giren year; need only submnt one affidavit indieadag Catrtat policy kBOrmation (if necessary) and under "M Silo Addma" the appUtant ahouN write "an bcadom la (City or town)." A copy of the affldwk that has been officially stamped or marked by the City or towns may be provided to the appnaat n proof that a valid affidavit is on Me for tfuture Permits or lieeaaes. A new affidavit moat be tined out each yea- Wben a home owner or cid= is obtaining a lkenss Or permit not related to any buskers or comaaa+cial venture (i.e. a doj lic , - i or pmdt to burn leaves eto.) said Person is NoT required to complete this affidavit The Office of Invesdgatbma would Me to thank you in advance for your cooperation ad should you have air goestiom, please do not hesitate to give us a Can. I fie Department's addren telephone and fan numbs: The Cotnntonwealth of Massubusetts DgMtMWt of Industrial Accidents OQIa of hme5 1ptions 600 Washington Street Boston, MA 02111 Tel. a 617-7274900 ext 406 or 1-877-MASSAn Fax 0 617-727-7749 Revised I1-22 t)6 www.n=.gov/din '°•"R TOWN OF YARMOUTH r•�' E �a BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. - job Location: N tuber :fttm Village Owner of Property: b w C nstruction Supervisor: - Address: Licensed Designee: (If other than Supervisor) 2.15 Responsibility of each license holder. =07-A�eMl,�t4p�l 9 Q2�9 License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the constntction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVER E: 1 have a cusurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No 0 If you have checked ygq, please Indicate type coverage by checking the appropriate box A liability insurance policy Other type of indemnity ❑ Bond �] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required try Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent ❑ Signature: Building Official Approval: • * .�3rn •Y^RHO th C TOWN OF BUILDING YARMOUTH DEPARTMENT PLEASE PRINT. job Location: _ CONSTRUCTION SUPERVISOR FORM Owner of Property 1131I syi7 �F— y/[uyl►n'v7/ t. Construction Supervisor. T �(CG J"d 9. Wdo� B�,% �7 S3�1? - Name /License No. Phone No. Address: I.I .� �f� Gd�P oGc� , ✓ casf�r� MA O26 3 I Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license' holder. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1.2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit. applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities tinder the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked yu, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Ownels Agent Owner ❑ Agent Signature: Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section It 1.5, I hereby certify that the deb is resulting from the proposed work/demolition to be r conducted at L , Work Ad ss Is to be disposed of at the following location: r Ja„Mkg. e� tea. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. 09-05D Chapter 111, Section 150A. Signature of App cation ylyl�� GK# 82i� Permit No. J� Date npin• Inn CERTIFICATE OF LIABILITY INSURANCE �02115111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR® REPRESENTATIVE OR PRODUCE{, ANDTHE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policypes) must be endorsed. if SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require -an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such s FRODUCER 781-935-8480 DeSanctls Insurance Agcy, Inc. 781-933•O645 36 Cummings Park Woburn, MA01801FRAJOULERMCMUS-2 I FA AFF a aISINkED MCMUSA, LLC 4AStreet Burlington,MA01803 . vmmutA6CNA Insurance Com antes vs-FlERviliLloyclsofLondon tsr*RcEnduranceAmerican Specialty rEuPER -Acadia Insurance Company NSU M I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TWO OFINSURAees POLICY NUNM W. Lair 5 A . GEHERALWaIM X COMMERCIAL WNEPAL LUUnY aA&rs4t4DE OCCUR X BWContractual 4013301266 01MIu11 - -i 01/19H2 rArmnrna ;2; _PREWESMOOWOMFINI s 1A00A S 100. MEDEXP aye s 6 PERSONA.aADVIN.IURY I 1D= X XGU hazards GENERALAGGPEoATE a 2 000 GEHL AOGREGAYE ULUTAPPLE3 PER POLICY X Pao' tot PRODUCTS-COMPIOPAGG a 2.000. _ A AUTOMOBLELIAI Mrn AWAM ALLOwNEDAUTOS SOH31AEDALROS HIFMA NN NON00M)ALITOS 4020643052 INSURED DOESNT OWN SCHEDULED VEHICL 01/1/111 COMBNEDSrra.ELam mcdcIsrul) BODLYINE.RYIPapw 1 BODILYKJUW w8=kat) 01MOR2 PROPPATM IPara�a. E aMe 1AOOA a— X S s X s a A X UNEMUAUU �stw X OCCUR aAa�rAOE 013301249 OV10f11 MV12 EA0 OCCU1113 CE a 8D00,000 s D DDD DEDUCTIBLE FETEW10H S 10,000 X a A AND LIANU Y AwpRemmopfflAmmmemouim t Fx[1LDED7 r ewer uur N OF OPEM11M below NSA WC4013301252 CT, NH 01/19/11 01H9H2 cs X u :;UTa -. - a EL EAwAccman sCFMCEPMBRER 1,000 EL DISEASE- EAEM L 1000000 DeASE•P'OLICYUdr I 00 C p lIudon Liab uildersRisk lamizwws CC101008913 (s11t/s3M) 03101/10 0211y0 11 I0w2t1QM2 SRtlmRs ms) DESCPUADDI[ IONA INSURED NIr ENI O REATE(AdschETMANR�EQUIREDB WRITTENI:ORWCT" ADDITIONAL MSURED LIMITS ARE NOG Project: Renovation i Addition at Taylor Bray Farm.103 Bray Farm Rd. Yarmouth, MA. Town of Yarmouth Is listed as additional Insured as respects to the G Auto, 3 lhnb po6eles. Town of Yarmouth Is a Named Insuredonthe Town of Yamtouth 1146 Route 28 South Yarmouth, MA 02664 YARMO-2 I SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RE►RESMA7M C 1988-2009 AC OR ACORD 25 (2009109) The AC ORD name and logo are registered marks of ACORD i i - Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License Lkense: CS 8M Restricted to:. 00 ,..RICHARDS WOOD,, ,I 115 RED MAPLE RD 5 ,;r , BREWS_TER. MA M831 J ;a Expiration: W7Ro11 ('ommLa�F«.er Tr#: 5680 t .. , o. TOWN OF YARMOUTH d` Building Department = Town Hall Yarmouth, MA 02664 (506) 396-2231 ext.1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-11-390 Applicant Name: Richard Wood Applicant Phone: 6175481041 Building Location: 0108 BRAY FARM RD NORTH Owner's Name: TOWN OF YARMOUTH Owner's Addres 1146 Route 28 f Owner's Telephone: South Yarmouth MA 02664 (508) 398-2231 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 4/6/2011 Issue Date: Expiration Date Comments: Map/Lot: 151.24.1 demolish rear part of structure - summer kitchen, porch and foundation, place construction trailer REVIEWED BY: 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: 17 RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 4/6/2011 .O�. TOWN OF YARMOUTH o y BUILDING DEPARTMENT �'�»•,s�� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN -OFF FORM State Building Code (780 CMR) Chapter 1, Section 112.1-Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notifyall utilities having service connections within the structure, such as water, electric, gas sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meter d regulators, have been remov d or aled an plugg d in a safe ter >�l'n� -- /Dfl �x-m-� manner." ,,,,t / "All debris shall be disposed of il`i acc rdance wi 7 10CMR 1175.91 P Building or Structure Loc ti / ap: Lot: Owner's Name:7WII dflress:(ttl(� Od�c Phone: Contractor's Name:/VC/ L6J. Address;4vrA,,Sf-ryet Phone-617"P) —j90U NStar: Date: By: Title: National Grid: Date: Water Dept.: Aoard of Health: Fire Dept.: /Historic CCo�� issiou/ Verizon: By: Title: Date: 4��ei 11rl By: Title:S�s G Date: '/- (-/- I By: j r r `-r p y Title: be 2 07 N«<<i"`- ' Condition: No �r�v..� ove✓ S`/`�Tp'" t1 r`"( `]� .� µ ,,/�t.. a VL lxKc Lt.% F-el Date: By: Title: I Date: 9// By: Title: Date: By: Title: Comcast: Date: By: APPROVED [4�W(7n1Am,6.Sjb,, AR 18 2011 YARMOUTH OLD KING'S HIGHWAY TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: pp p r n �j� Building Site Location: � ja'r Dray �Qv ty� jog tray 1`Q yMy0 d I v 0 Proposed Improvement: kehvvaf lak ' kr( CL flI&� /� I 1 (� 17-5 - o Cell Applicant: AuiA f ick kAg� Jylv:i-Jj eAl Tel.No.: r)-QQn-1_j900 Address: (► .%i✓eef, Ifiy��l- , MA o 1903 Date Filed: �% / •'Ifyou would like e-mail notification of sign off; please provide e-mail address: ! Ll/00J 6-Acm US a ► C 0 ✓� Owner Name: Owner Address: Oak Owner Tel. No.: sop -M-- 22-3 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: TE: y Z/-Z/— M YARMOUTH FIRE & RESCUE Commercial Building Permit Sign Off Project Name:Bray Farm Project Contact Name:Rick Wood Address:108 Bray Farm Rd Phone # 617-548-1041 Y NO NA Subject Regulation E S ® I ❑ I ❑ Access for Fire Apparatus 527 CMR 25.02 Building Numbers MGL Chapter 148 sec 59 *Flammable gasfilquid storage 527 CMR 14.03 Fire Lanes 527 CMR 10.03(10) *Service Stations 527 CMR 5 & 9 *1/azardous Materials Storage 527 CMR 25.08 *Xltchen Exhaust Systems 780 CMR, 527 CMR 10.03(8) Extinguishers 527 CMR 10.02, Chapter 148 sec 28 *Fire Alarm Systems/CO detection 780 CMR, Chapter 148, 527 CMR 24,CMR 31 El El I N *LPG Storage Chapter 148 sec 9,10,28 & 527 CMR 6 Pesticide Storage 527 CMR 37 *Sprinkler Systems 780 CMR & Chapter 148 sec 26 A-1 Storage inside/outside Buildings 527 CMR 10.03(5) *Upholstery 527 CMR 29 *Trash Containers 527 CMR 10.04 & 34 N El I El Any Hazard to the Public Chapter 148 sec 28 *Curtains, Draperies, Blinds 527 CMR 21 Description of planned project/other requirements: _ onXhistoric building. *YFD permit required -depending o occupancy and submittal Plan Reviewed By: Capt. Sawyer Date: 3/31/11 Copy for Applicant® Copy Building Dept. Copy to Fire Prevention TOWN OF Y A R M O U T H DEPARTMENT OF 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSEI'17S 02664 COMMUNITY Telephone (508) 398-2231 Ezt.1277, Fax (508) 398-2365 DEVELOPMENT March 24, 2011 NSTAR One NSTAR Way Westwood, MA 02090 RE: 108 Bray Farm Road North, Yarmouth Port Service Disconnection Request Dear NSTAR: The Town of Yarmouth is the owner of 108 Bray Farm Road North. There is a vacant farmhouse and the Town has contracted with MCM USA, LLC to demolish a portion of the house. The Town is authorizing temporary termination of the electric service to the property. The electricity to the property may be shut off as of March 24, 2011. Please feel free to contact me at (508) 398-2231 ext. 1277 or icoutinho@varmouth.ma.us should you have any questions. Respectfully yours, 9Jennif r Coutinho Program Coordinator I EL ECTR/C NSTAR ElecMc -Work Order Application For KathyWhite Customer Request In -Service te: NSTAR WO Received Date: Service Address: Street Atrd Fuzw horpuite: Town: Zip:Q�1i6c� Customer Of Record: Customer Responsible for Payment of l�th/y Electri Bill / . Name to appear on Monthly Bill:_Auk uk Or %Crf✓i[vUI DEUL- QUUame: Billing Address: driff[1,i �� Te3Rrtvuv2:. TaxkA t4.v bar.. FEa&WV AcomW or defer plumber of app&caWe.L Property Owner Name (f dfferent from above): Owner Address: jC PI Q Owner Phone Number. Party Responsible for Construction costs associated with work order (if different from above) Address: �ju IM E_ Phone Number. Please Note that Articles of Incorporation are required for new commercial NSTAR Customers Type of Service Requ ted: (Circle Appropriate) New Service S vice U rade Service Relocation Temporary Service Pole Relocation i ecURe ec Service Removal Metering Only OH Service from Pole, Pole# : UG Service from; Riser -Pole # : Padmount # : Customer Loading Brief Description of Work -type of Load 114ew Casa Load tu KWA sli (sAtmstg T,wiq�dw Lighting Electric heat Air Conditioning Refrigeration Cooking Electric Dryer Water Heater Process Equip. Motors/Elevators Miscellaneous Totals Number of Meters Required: WWI Residential: Commercial: Public: Main Switch Voltage: Amperage: Phase: Service Voltage: Amperage: Phase: Facility Type (ie: school, hospital): New Building Square Feet If more than 1 meter is required, how will meters be labeled? ('ie: Unit 1, 2, etc, Unit A, B, etc.) (.. u�1F Y . , . . , .ter � Y_���- •• _S •1 �1f� ,. -If `. ♦[-.. I - - w•- - _ �.} .. , .;S -; .. .. �1\ � I... ... ... .. .... .� .... .. .. .... _. _. . t ... t :• .. _. _.. .. �. .' � 1 1 �t 1 .. ... ' �` � I � .. .... Page 1 of 3 Robbins, Russ From: Charlie Van Voorhis [cvanvoorhis@dvvarchitects.com] Sent: Tuesday, April 12, 2011 2:45 PM To: Robbins, Russ Russ - Here's is the text of a letter I plan on sending to Ken Bates after I get a chance to chat with him about its contents: April 12, 2011 Mr. Kenneth Bates, Inspector of Buildings Yarmouth Town Hall 1146 Route 28 South Yarmouth, MA 02664 Re: Taylor Bray Farmhouse Dear Inspector Bates: I am writing in response to your questions regarding the building permit application for the above -referenced project. Since our telephone conversation yesterday, I have done a little more research and submit these findings for your review. Question No.l is your request under Article 1101.2 of the Massachusetts State Building Code for a report of non -code -compliant building features. To my knowledge there are no features in the proposed renovation that do not meet the Building Code requirements for a House Museum, so long as the occupancy is limited to 49 or fewer. I had mentioned on the phone alternative exit signs that would have required your approval. However, after reading the code again, I believe that because the farmhouse only requires one exit (Table 1021.2), even though it has more, exit signs are not required under Article 1011.1 Where required, Exception 1. 4/12/2011 Page 2 of 3 The B Use Group is consistent with both House Museums under Article 1101.3 - Special occupancy exceptions - house museums in the Existing Building Code, as well as, in the Building Code under Article 303.1 Assembly Group A, Exceptions: 1. A building or tenant space used for assembly purposes with an occupant load of less than 50 persons shall be classified as a Group B occupancy. As far as the toilet room is concerned, I have calculated the occupancy according to Table 1004.1.1 for Business Uses, one occupant per 100sf of the gross floor area. Given a gross floor area of 1,092sf the occupancy load for the farmhouse is 11. I believe that under the Plumbing Code 10.10: Minimum Facilities for Building Occupancy Other Than Residential - Plumbing Fixtures 1814, In business or commercial establishments (except industrial) that contain less than 1,200 gross square feet of floor area ... one toilet room located within the establishment provided with the number of fixtures according to the standard set forth in 248 CMR 10.10(18): Table 1 for employee facilities, shall meet the minimum requirement. Therefore I believe the single accessible toilet room as shown in the permit application complies with both the Building Code and the Plumbing Code. If you have any further questions or wish any additional information, please do not hesitate to contact me. Sincerely yours, Charlie Van Voorhis, Principal If you have any questions, please feel free to contact me. -Charlie Charlie Van Voorhis, RA, LEED AP Durland • Van Voorhis Architects 628 Pleasant Street - Suite 322 New Bedford, MA 02740 508.993.6567 t 508.993.6581 f 508.277.9225 c 4/12/2011 Page 3 of 3 z V Y 4/12/2011 3�oF•YgRc TOWN OF YARMOUTH -14 BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 Fax 508-398-0836 MEMORANDUM TO: Site Plan Review Committee FROM: James D. Brandolini, Building Commissioner DATE: December 22, 2010 SUBJECT: 108 Bray Farm Road Yarmouth Port I have reviewed the October 26, 2010 Site Plan Review Application Package, Comment Sheet and the December 22, 2010 plot plan. Included herein are my comments concerning the proposed use change and proposed renovations for the primary structure located at 108 Bray Farm Road, Yarmouth Port My comments and findings are as follows: -The structure in question in which the proposed renovations will take place and the use changed to historical educational use, is located 35 feet from Bray Farm Road, as depicted on the December 22, 2010 plot plan -The lot and structure in question conform to the provisions of zoning bylaw Table 203.5, R-40 zoning district (land area lot coverage and setbacks). Therefore the proposed renovations maybe performed without relief from the Board of Appeals. -The proposed educational use is an exempt use pursuant to the provisions of MGL 40A, Section 3. -Based on the proposed occupancy and arrangements of the building in question, a Site Upgrade, cited in zoning bylaw Section 301.2, is not triggered. -All work shall comply with the applicable provisions of 521CMR and 780CMR. KEY McMusa; uc. SITE CONSTRUCTION FENCE �4 A S""K &ff W bMiL 0l9 90, EXISTING STORAGE CONTAINER -IN N 1 MCM SITE TRAILER DUMPSTER CONTAINER � a TRAFFIC FLOWIPARIONG 6s METER LOCATION. ACCESSIBLE PARIONQSNTRANCE E �f SEEDET ONL-t.1 l ` "FIELD RELOC TCOM PARKING .OUTROUSEX i .r o • � � ' 1� r , . 7 CONC OOP ` 1 V.5'4l-TO WrrLA5- 1 APPROXIMATE LOCATIONOFSMt TANK f � � - OxISTIN3 61 I ION I 1` I 39,�, ,I -To I , ell I �-- — — —7 — --�"7 --� WETLAND AESOURCEARFA W f ' , 1 I ACCESSIBLE PARNWENT614CE SIGNAGE I SEE DErAIL20N 6ij PARKING 1 SITE PLAN . SCALE 1 •=10'-0• . F 1 l r NORTH PROPOSED LOGISTICS PLAN 3130/11 I TOWN OF YARMOUTH Building Department BUILDING , , (508) 398-2231 ext.261 PERMIT NO :eos-,o98,: PERMIT ISSUE DATE 5/7/2009, , PRa ::::::: : APPLICANT .Darlene Johnson -Morris JOB WEATHER CARD PERMIT TO Alterations AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT R-40 Bldg. Type: SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE= USE GROUP= LOT SIZE II construct boardwalk as per plans submitted 4/29/09. REMARKS AREA (SO FT) EST COST ($) $15,000.00 PERMIT FEE ($) OWNER ROWNOFYARMOUTH BUILDING DEPT BY ADDRESS 11146ROUtS28 South Yannuth MA 102664 INSPECTION RECORD Date Note Progress - Corrections and Remark 2"ZI 11 I r CONTRACTOR LICENSE 092954 23 Bog Road W est Yambuth MA 02673 5087784711 PHONE 15083982231 FIELD COPY In P TOWN OF YARMOUTH Building Department g U I LDI N G BUILDING - (508)398 -2231 ext.261 PERMIT NO B-09...... . _ . _ - PERMIT ISSUE DATE :, 3/19/2009.1:PROPOSED USE APPUCANT TeirenceDcyie " ............................ """""""""'", JOB WEATHER CARD PERMIT TO Repay ---- AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R 4 LOT SIZE CONTRACTOR bam - strip and reroo(, 14 squares paper and vent to code REMARKS LICENSE 084696 Doyle. Terrence 1607 Long Pond Road AREA (SO FT) EST COST ($) $5,400.00 PERMIT FEE ($) $0.00 Brewster MA 02631 5082379004 OWNER jTOWNOFYARMoLrrH BUILDING DEPT BY ADDRESS 11146 Route 28 SMMYanrouth MA 02664 083 PHONE 5982231 INSPECTION RECORD FIELD COPY Date / ^ Dote Progress - Corrections and Remark Inspector ,a - a 00 Yefa>3t:a�kes b $om EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 AOc (508) 398-2231 Ext. 261 CONSIRUCIION ADDFXM: /� l ✓ ASSESSOR'S INFORMATION: Map: Parcel: OWNER: NAME PRESENT ADDRESS TEL A ,Q CONTRACTOR:✓✓C.Ci:Ce Da 6 u % G+�H G eW NAME hsAluNO ADDRESS TE4fA 71CNj ❑ Residential ❑ Commercial , Est Cast of Construction S J yVZJ Home Improvement Contractor L(c. 0 Construction Supervisor LIa f Work man's Compensation Imurance: (check one) ❑ I am the homeowner)eLam the sole proprietor ❑ I have Worker's Compensation Insurance insurance Company Name. � �},[�( S 4 rL L2� Worker's Camp Policyfl or WORK TO BE PERFORMED ❑ Tent (FhvRehrdantCenittateattached) Duration Wood Swvik Shed D Siding: / of Squares 0 Replacement windows D ReplacemeM doors: R ❑ Re -roof 0 of Squares ;4.,Id i ineaesO () going ova !ryas ofesisting roof vne debris will be disposed of at: Ih/Kt�.✓ I declare under penalties of perjury tbat the will be just cause fordenial or revocation o of Facility true ��aaee++'ww'the hat of my kmwlalge and belies I understand that soy tube answa(s) k Section 1. Appliant'sSignatuml \ uC/ i Deter Ownaa Signature (or anachmeMl Data Approved By: Data Building OScial (or designee) Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone•. O Yes ❑ No Water Resataoc Protection District: Within 100 R of Wcdandi: ❑ Yes O No 0 Yes 0 No S!Mloym (full and/or part -tithe).• I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. mnrance required.] 3. ❑ I am a homeowner doing all work mysel£ [No workers' cotrtp. insurance required.] t 4 f • The Commonwealth oflliassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwtt.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busiaess/OrganiratiorAndividuan: p r-- Address: /6 c) 7 4_-.1 City/State/Zin: Z.C.3( Phone S aX " Z-? 7 —20c*/ Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I have hired the subcontractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.t S. ❑ We are a corporation and its officers have exercised their " right of exemption,per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction ?. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs ME] Other. Any applicant that checks box Al mat also fill out the section below stowing their workm' eonTensatim policy infatuation. t Homeowners who submit this affidavit indicating they ne doing all work and then hire aside contractors roust submit a new affidavit indicating such tContractom that check this box must attached an additional sheet showing the name of the sub-contracton sad state whether or not those entities have employees. if the sub -contractors have aMloyca. 6" must provide their workers' comp. policy number. I am an employer that Is prorlding workers' compensation Insurance for my employees Below Is the polley and Job"iite Information. .4�/r% Insurance Company ✓�.0 G Policy # or Self -ins. Lic. M In/i' 3 G 2. 6Expiration Date.—./ Job Site Address:City/Statemp: 4,., nz i✓!n Attach a copy of the watlkers' compensation polity declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S11500.00 and/or one-year onment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the r. Be advised that a copy of the tement may be forwarded to the Office of I do hereby certify under t/he %[[ Si Wee, Phone #: Offlc al use only. Do not City or Town: area, information provided above is true and correct. or town ci flWaL Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: TOWN OF YARMOUTH 1116 ROUIT 28 SUUTI I YARNIOUTU MASSACI IUSfir1S 02661 rcicphunr (508) 398-2231 OLD KINGS HIGIIWAY REGIONAL. iiisTORIC DISTRICT COMMI7TL'E APPLICATION FOR CERTIFICATE OF EXEMPTION '09 MAR D eM 2126 YARMOUTH TOYH CLERK Application is hereby made for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans, drawings, or photographs accompanying this application. TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK D 3� r�, ASSESSORS MAP N 15 1 OWNER Tty n [r-l� 'i o I-Mn ur ASSESSORS LOT # 10 HOME ADDRESS I (� [� �C eC - r r, r L}� in A TELEPHONE 0 & 6 P231 AGENT OR CONTRACTOR Khf��r n 1 ADDRESS_ c me) I TELEPHONE 0_5p�$ THIS APPLICATION IS FOR EXEMPTION OF PROPOSED EXTERIOR CONSTRUCTION ON THE GROUNDS THAT: ( ) IT WILL NOT BE VISIBLE FROM ANY WAY OR PUBLIC PLACE. IT IS WITHIN A CATEGORY DECLARED ENTITLED TO EXEMPTION BY OLD KINGS HIGHWAY REGIONAL HISTORIC DISTRICT COMMISSION. (Cheek applicable box) PROPOSED WORK: DESCRIBE WORK, SHOWING LOCATION ON LOT, AND, IF AN ADDITION IS INVOLVED, EXISTING BUILDING. SHOWING LOCATION OF `IL 11�P�oCe. e�C15-1-;n r0crt l�I Q�P ,�i- �'jraIi-ec'J)roj n 1� :n "weahe,r�oocL,:� Chon9e moer�oJ) bud for ar�d o_p p eo +-a.nce 40 mo 0) ey-NsJ-:,,9, Signed Date__ Nired OOwne - ntractorAgent is aware that a Permit isreqom the Building Department. Receivedby OKHC The certificate is hereby Date -1/1 0 q Date Check# K.l A By C7 ( APPROVED ( ) DENIED ( ) iJ RECE: t FEB 2 G 2009 I YArt:.1G!.'T+ ! OLD KING APPPROVEU EEEB 2 6 2009 YARMOUTH .,A% q — IF, 003 J y O ..+•+wr'wYe+ww+w•Rur.sY•nr �_�. .. _. rwwM 4. Board of Bsildlp ulau us *ad 5taadar a Construction Supervisor License License•. CS 84600' w Birthdate: all111965 17, E=plrlpom,' 8/11/2008 'fT 2289' �. f estriction: ,00V ,TERRENCE T DOYLE' ' u. 861 ORLEANS RD, HARWICH MA02845��� Commluioaer f+ •f J .nY s..,�'y a t .n x ,xw � rl i Find a Licensee - Microsoft Internet Firplarer � :- Poe ELSE View Fawkes Took Help 00ack - ® - i p Search Fawkes • O Li a .44 'Address - _- - - +] fhnp:Jlm.state.ma.usldpslicenseeht.aspisAeshis iv ® Go Lhks Favortes x _li] Add.. In organtze.. - ` - - - Del OUnksyVIP Ic J .d!11 Q Amamn.Corn onine Sho;Wg for..rlM� i - WO 4] AOL.com • Welcome to Armica ... • - Aomwoom s--------_—.--------------- ----� Sath YannaRh L6rery !-------- --- --- � '. Department of public Safety Licensee Lookup i -- The Ibt Is current as o/ M4dMrmy, W relit 11, 7009. You can soarcn/Hbr the ikemee ast by any of the criteria below. - License Businesses Individuals j t Select Lioeue Type Home Improvement Contractor �! Search by Lfcerse ta,nber 1142115 t Search f t Search PAPAS F LICENSE TYPE BUSINESS NAME CONTACT MANE LICENSE RESTRICTION ABIRESS STATUS f I Horm ImprovementContractnrl Terrence T. Doya I Doyle, Terrence 142115 1 - 11a Moody Rd Harwich Port, AAA 02646 Eftred �I JM mho Pace http:lldb.state.ma.UsldpsAcwseelst.asp... 1111111111 1 I I fobternat j Monday, Mar 16, 2009 10:27 AM -3 Find a Licensee - Microsoft Internet Explorer ;a ,- Pk Edt %low Favortes Tools Help r - ©Back - ® - E) A tltl l A Seam Address JJMtttp:f/db.state.ma.usjdluXwseek.aspMesJtS rr ©C',o... U Favories x . • i - _- _ - _ _ .-. �� omarize... - 't _ - �Del — - -- • r , / r 1 Aowzon.corn ovine Shoppiq for.. �Y/ ' • / r® AoL.can-Ydelcorne to America... -_------'------------F 4D South Yarmouth library Department of Public Safety Licensee Lookup The tit is arrent a of w.arwday, March il, 50M. You an rnrchNhor On Bconroe Bit by any of eia criteria balm. License Businesses Individuals Construction Supervisor [v Select a lke se TWo Search by ticxee Number Search Search Results �LIC INS TYPI BUSINESS NAME CONTACT NAME LICENSE RESTRICTION AB•RESS omstructlnn Supervisor l N/A �1Doyle, Terrence I SM96 100 Nerwlch, µAi J l f t. STATUS --.�.... r .�_..._._�_....�.red t v IM Done irtemet Monday, Mar 16, 2009 10:26 AM THE CONtMO.YWEALTII OF b1ASSACHUSUFTS Board of Building Regulations and Standards Home Improvement Contractor Registration Program One Ashburton Place, Room 1301 Boston, MA 02108 Application for Renewal of Registration as a home Improve ent Contractor or Subcontractor - MCL Chapter 142A, 790 CM� R6 (PLEASE READ BOTH SIDES CAREFULL 1. BUSINESS NAME: Print the name in which the applicant is conducting byiintn 2. Mailing Address: � 6 07•' 1-dAl,9 Q0A,'?) JC 0 : 3. City JS i State: M A zip: D 2-6 / 4. Street Addre !if different): (Print street and Number, a P.O. Box is not acceptable for a S. Applicant type: Individual DBA _ Partnership —. Trust Limited Liability Partnership Limited Liability Cor Please (heck tare (See trtstrttctiotts on pack regarding enclosing a city or town registratio tn taxler DB 6. Social Security or Federal ID Number.. U 3 C/ &o a (t 2yi (: 8. Have you registered piously under law? Ifso,underwhat? C���.2JCiLII\\C�•yr 9. Individual responsible for Home Improvement Contracts: IXJ Y (See back of form) Last Present Registration No: Effective Date- Expiration Date- Date Entered: M BACK OF FORM (500) I 96 Area Code Telephone Number RECEIVED ,City. rate 8 2009 zip j - P -rivate Corporation 1 _Public Corporation ;pion DPS Special 9lctitkau name' law • dimsino 6) beck)t.:7.. .Number. of Employees i (See back of Foim) • Registratiog149: NZ 1( _J A4 Social 10. Tide of individual responsible for Home Improvement Contracts: _ DG[J.(1F2 11. Does the applicant or responsible individual hold any other construction related state, city; town licenses or registrations? Yes No T of License tx istratien Issued B lleense or re ' t Ex 'ration Date Name of License Holder - bJ G2 -4 S � f/ hil t? C,/Gg 1 _ _ 1 12. List all partners, trustees, officers, directors and major owners (10°/a or greater of ownership) of an applicant partnership or corporation below. Use additional paper if necessary. (See instructions below) Check here if you wish to receive an aoolication for additional ID cards for kev neurons. Last First MI Title in icant Business ei, Owner Address f 1 13. Is the applicant claiming exemption from the registration fee? (See the instructions on the back) Yes _No 14. Registration fee enclosed: S (see note (! 1, on back) t Guarauty Fund fee enclosed: S (see note 02, on back) If necessary, include two separate eertiGed checks or money orders - one marked "Registration Fee"; one marked "Guaranty Fund". See instructions on back for amount of fees. Make all certified checks or money orders payable to "Comnionwesith of Massachusetts". NO PERSONAL OR VVSINESS CHECKS WILL BE ACCEPTED TINLESS TIERY ARE CERTIFIED. Pursuant to Massac ct General Laws Chap A, I rtify under the pc Shies of perjury that 1, to my best knowledge and belief have filed all stateAjydurns and pa'd all a e equir u er law. } l l ��—� ,Stec--�• c3 / i7 /��i Signature of applicant or applicant's representative " Title held with applicant ,A false answer to any question In this application constitutes grounds for s i or revocation of the applicant's registration. Rev. 4-08 NGM INSURANCE COMPANY INSURED 55 West Street, Keene, NH 03431 Telephone: 1-888-646-7736 CONTRACTORS POLICY DECLARATIONS Named Insured and Mailing Address BRIEN WINSTANLEY & TERRANCE DOYLE 1607 LONG POND ROAD BREWSTER, NA 02631 Agent:HUDSON ELDRIDGE INS AGENCY AGENT PHONE : 508.945 0446 POLICYHOLDER INFORMATION Named Insureds Business: CARPENTRY -RESIDENTIAL Entity: PARTNERSHIP Policy Term: 12 Policy Number. MPF3626E Account Number: CACF5626E Producer Code: 20 0778 Effective: 11/26/08. (12:01 A.M. Standard Time at the address Expiration: 11/26/09 of the Named Insured stated above) - In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated In this policy, See the.attached schedules for Description of Premises, Property Coverage, Optional Coverages, Forms and Endorsements applying to this policy and Mortgagee Schedule if applicable. BUSINESSOWNERS LIABILITY COVERAGE LIMITS OF INSURANCE Liability & Medical Expenses - each occurrence S 2, 000, 000 Personal and Advertising Injury Limit S 2, 000, 000 Products -Completed Operations Aggregate Limit ; S 41000, 000 General Aggregate Limit S 4, 000, 000 Fire Legal Liability - any one fire or explosion S 500, 000 Medical Expense Limit - per person . S 10,000 Business Liability and Medical Expense: Except for Fire Legal Liability, each paid claim for the above cover- ages reduces the amount of insurance we provide during the applicable annual period. Please refer to section DA. of the Businessowners Liability Coverage Form. For policies subject to premium audit: Annual Audit Applies. Estimated Annual Premium: S 21081 TOTAL PREMIUM AND•CHARGES S 21081 Countersigned: By _ ;�, •zf'�/[\/ �'• j- 64-5470(9100) 12/26/08 NEW BUSINESS JC "0• " 09to , —,.. A.1 TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ , (508) 398-2231 ext.261 PERMIT NO : B=08-1289 .......... PERMIT ISSUE DATE 5=008_ _ : PROPOSED USE APPLICANT Barnstable 6;Wtj9hemR's Dept. - - - -: JOB WEATHER CARD PERMTTTO TENT I AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type: Commercial I SUBDIVISION MAP LOT BLOCK 151.24.1 LOT SIZE REMARKS BUILDING IS TO BE: CONST TYPE El USE GROUP R-4 ERECT TEMPORARY TENT - DURATION : 5/30/D8 - 6/2J08 AREA (SO FT) EST COST ($ $0.1 OWNER rOWN OF YARMOUTH ADDRESS 0108 BRAY FARM RD NORTH YARMOUTH PORT MA 02675 PERMIT FEE ($) BUILDING DEPT BY PHONE CONTRACTOR LICENSE 0 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BYTHE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT I APPROVALS OM STREET 1 1 J 1f 2 2 � 2 3 OTHER- 1 2 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE. of r TOWN OF YARMOUTH Building Department BUILDING ' - - _ _ - _ - - _ , (508) 398-2231 ext.261 PERMIT NO B708-1289. • 51k008PROPOSEDUSE :PERMIT :: _ _ ::: ISSUE DATE .. APPLICANT BamstableCountyShemft'sDept. ---------------------------- JOB WEATHER CARD PERMITTO TENT AT (LOCATION) 101D8BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: LOT SIZE ERECT TEMPORARY TENT - DURATION : 5/30/08 - 6/2/08 REMARKS AREA (SQ FT) EST COST ($ q0.1 OWNER OWN OFYARMOUTH ADDRESS 0108 BRAY FARM RD NORTH YARMOUTH PORT I MA 102675 CONST TYPE 5-B USE GROUP R-4 PERMIT FEE ($) BUILDING DEPT BY YOUR SPECIAL ATTENTION Is called to the following: PHONE CONTRACTOR LICENSE This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this jurisdiction Including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit is Issued must be displayed on premises. The Department must be notified and Inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimum of three piled Inspection, namely, 1) Footings, drain file systems, foundation and basement walls, when walls are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanical systems are installed. 3) Final Inspection when building or structure is completed On jobs Involving reinforced concrete work, Inspection must be made after steel is in place and before concrete is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been Inspected and approved by the Department in accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee is also charged predicated on the extent of the variation from the original plans. Permits are not valid if construction work is not started within six months from date permit is issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been Installed Painting or decorating is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying budding. APPLICANT COPY a r TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ , (508) 398-2231 ext.261 PERMITNO B-67-4336_ ISSUE DATE :: sii noo PROPOSED USE ............ PERMIT. APPLICANT ----c---anop-------------------- JOB WEATHER CARD -ChasePERMITTO Misc.A'ent AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRIC R-40 Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1151.24 BUILDING IS TO BE: CONST TYPE USE GROUP LOT SIZE O REMARKS erect temporary tent - duration: 6=7 - 614107 AREA (SQ FT) EST COST ($1$1,000.00 PERMITNQ ($?�$6.00 OWNER ITOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146ROute28 South Yarmouth MA 102664 INSPECTION RECORD Date Note Progress - Corrections and Remarks CONTRACTOR LICENSE 0 P.O. Box 46 Mattapoisett MA 02739 5087582055 PHONE 15083982231 FIELD COPY EXPRESS BUILDING PERAUT TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: `U$ F>r&y F&rU4 ASSESSOR'S INFORMATION: �• Map: s( Parcel: Z-f, / OWNER _l U"1.y// Q� L�Q.htt oy ' ;l7 , Pox 9<i ❑ Residential 0 Commercial FsL Cost of Construction S Home Improvement Contractor Lic. M Construction Supervisor Lie. M Workman's Compensation Insurance: (check one) 0 1 am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation insurance Insurance Company Name. Worker's Comp. Policy# Permit r & / _�3 Fee f 'Permit expires 6 months 6om Issue date. VILNUE0 MAY 18 2007 BUILDING DEPT. OZ73 J b&5- 75g- 7ELr WORK TO BE PERFORMED Teat (Fire Retardant Catilicame tattar6 2— Wooer soove P PROVED D Siding: r of Squares D Rcplaeemerd doors: r D Replacement windows: Pn 182007 0 Re -root r of Sguares () Stripping old shingles* () going over layers of misting roof e A RM O U TH 'The debris will be disposed of at Location of Facility I declare under penehties ofperjury that the statements herein contained are true sod correct to the best of my bwwkdge and beGet I understand that any Nse answo(s) willbe just cause for dmiall or of my license and for prosecution undo MO.L Ch. 268, Section 1. Applicant's Signaaae: �'I `7 r '�' �� C�✓/i!!/L1L iy ¢— / %— 67 Owners Signature (or arachmera) Da: Approved BY Date — Building Official (or designee) Zoning District: R V D _ Historical District: A Yes 0 No Flood Plain Zone: Yes ❑ No Water Resource Protection District: Within 100 R of Wetlands: ❑ Yes -)� No d Yes 0 No 3101 Department oflndrtstria/Accidents Of `ie a of Investigations 600 Washington Street Boston, MA 02111 www.massgovId0a Workers' Compensation Insurance Affidavit: Bnilderl/Contractors/Electridans/Plnmbers Are you an employer? Check the appropriate box: 1. ❑ I am a empbyer with 4. ❑ I am a general ooatracbor and I employers (fA and/or part-time).• have hired the anb-oonftctDn 2 ❑ I am a sole proprietor or partner- listed on the attached sheet : ship and have no empbyees working for me in any copy [No worker:' comp. insurance Mob l 3. ❑ I am a homeowner doing all work myself [No workers' comp. iasnraae required.] t These sub -contractors have workers' comp. fi mote. S. ❑ We are a corporation and its . officers have exercised their right ofexemption per MGL c.152, f 101 and we have no employes. [No woriera' o0mp. insurance raNire&] Type'of project (required): 6.. ❑ New construction 7. - ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10-0 Electrical repairs our additions I L❑ Plumbing repass or additions 12.0 Roofrepairs'-- 13.❑ Other * . j -,.r. m -; ..�.�. w w • ssw . u w . �pu ucjuw zwwmg mw warms- ea�os poHc b&mnadoL t Homeow neve wit nbrmt ilia effidnit iedicetiNg dwy are doing on wart and Lien h6w outd& ton.' ' -0 a more taimit a new attidetk indicating such tCantrnetaea tier check ilia butt mma attached mn additiood diet eEowA28 tie new of do V&cca adore end their wodm, eat policy informatiod I an an empleytrthat b ptmMna Workers' compensation h0untnce for my emPloym Below is thepoliq and Job stir befonnadAL Intuatm nce Company Nat= Polity # or Self -in. Lic. M Expiration Date: Job Site Address:- - City/Statcg4: Attach a copy of the workers, compensation Polley declaration page (showing the Polley number and explratlon date). Famlue to secure coverage as required under Section 25A of MGL•c,152 can lead to the imposition oftximinal penalties of a tine rep to $1,500.00 and/or one-year fi prhoameat, a, well as civil penalties in the form of a STOP WORK ORDER and a fine of rep to S250.00 a day against the violator. Be advised that a copy of this statement may be forwwdrded to the Office of Investigations of the DIA for insmrance coverage vcff=titm I do hereby certify under the pairs and penaltln of perjwy that the lnforaeatlon prov1*d abmv 6 true and conceit e 1: 0AId use only. Do nor write in thlr ant, to be completed by city or town ohL*E City or Town: PermWLieense # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. Cttyllbwn Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: jL]normatiuu auu .L1J0&& �..��..�.. 152 requires all employers to provide workers' compensation far their employees. Massachusetts General Laws papa is defined >n "...every person in the service of another trader any contract of hire, pursuant to this atatn� or written." . express or imp ed, artnetship, asaoaatton, corporation lii Other legal entity, or any two Or more An papioyux is defined as "an individual, p curatives of a deceased employer, or the of the foregoing engaged in a joint enterprise, and inchtdiag the legal repres However the receiver or trustee of an individual, parumbip, association or other legal entity, employing empbyees. owns of a dwelling house having not room than three apt and who resides therein, or the occupant of the who employs persons to do maintenance, construction or repair work on Bach dwelling house dwelling hottse of another or on the grounds orbuilding, appurtenantthereto shall not because of such wVbyment be deemed to be an emploYa." MGL chapter 1S2,125C(6) also sterns that "every state or local licensing agency shall withhold the Lisnance or renewal of a license or permit to operate a business or to construct buildings In the comtmonwealth for any renewal aowho has not produced acceptable evidence of compliance with the insurance coverage required - applicant MGL chapter 152, §25C(7) states "Neither the commonwealth trot any of ib Polideal sabdiviaioms shall cater min any contract for lire performance of public wodk until acceptable evidence of compliance with the fnsttrance requirements of this chapter have been presented to the contracting suft ty." Appiita�a Please fill out the workers' compensation affidavit completelyr by checking the boxes that apply to your situation and, if . necessary, supply sub-conrlictor(s) narne(SI addresses) and pbone number(s) along with their certificates) of . insurance. Limited Liabt7fty Campanies (LLC) or Limited Liability Partnerships (L.L.P) with no employees other than the members or p =M are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confIImadon of insurance coverage. Also be sure to sip and date the aMdavlL The affidavit sbould be returned to the city or town that the application for the permit or license is being requested, not the Department you have any questions regarding the law or if you are required to obtain a workers Industrial Accidents. Should' compensation policy, Please call the Department at the mtmba listed below. Self insured eonq)md a should enter their self-insurance license nambtr on the line City or Town 0Mdal11 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inviz6gatiom has to contact you regarding the applicant Please be sum to fill in the perrt/liceme numba which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given Year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or towel" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit mnst be filled out each year. Where a home owner or citizen is obtaining a license of permit not related to any business or commcrcial venture (LL a dog license or permit >n bum leaves etc.) said person is NOT required to complete this affidavit . The Office of Investigations waa]d bike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number The Commonwealth of Massachusetts. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 eat 4W or 1-877-MMSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia nFr -3Q ?00 r tIJFi Od: (13 , i tir:r r y in ,II an( P rtt'TI N ;. 15�35:'i!o31 t1 r. Oa ^AcoRo CERTIFICATE OF LIABILITY INSURANCE CHASE ,l'� ATE 1L'LL'DJfM„ _ �_31�0�130/1) aiao� cs THIS CFRTIFICATF IS ISSUED AS A MATTEROF INFORIAAFfON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAIL Berry lusurxnco Agency HOLOSR. THIS CERTIFICAlk EICES NOT AMEND, EXTEND OR 9 lTain Stzoet ALTER THE COVFP-AGI" ArrOROFD BYTHE POLICIES BELOW.-� F•zanllil( Kh 0203b Proue T 900-824-5201 2a/ 1�:E-�2C-ESi+. INSURERS AFFORDING COVEIIAGL• ! UMC 0 1r:5uriD ! ;r15;P.Es - t'nePoaron Zr.n . Cry -Y1 wsuRE,II. tllo:eaa_lo_ Retail uppliers Chaco Canopy CompHnjr, LLC' INSUR-!1C _ - — Daniel Chaae 4 Hiekyla Land P.O. Box 46 ja15UReRD. Mattapolaott Dill 02139 COVERAGES THP POI.t-ES CF INSURASCF USTCO BELD'.V I1-VC VZ-'4;CAUFO TO ThF• INSURED r AWO PDJvC FOR 1HE PC+L'CY PrML O NO —CATS- ROTY.1TH3rA!.LI:Na ; ANY RS:•U.PCv!NT,'f f krA OR L'GNChIO\ Or ANY ..:wlra-C r I'iF OTI 1':1, D3CLCJFNT 77:711 FESPECT.TO LATCH THIS :ERTIFI CATS 161A r NE I$jUn i Or. ' MAY PEPITAIN, TIIE :'+SIIRAWS AFFCTZE`CD Cr r�.F P71. w_S U:iSC4.1! iC H-PO -. IS SUe�!CT TO ALL THE TvR:.t$. EXGLUSIC%S A•IG C:i!:DITRI'+.•. OF SUCH PCLIOICS AGZR1!C 4TE LPt ITS SHC VP'+ 4`AV ILL :'L LICEN HCF7.1+.leD BY P..IO LA VS F3iC'rSL7C'L"-_�-�_—.•-------• - ---- UUTS ;.TR4.1brO_ TYPE OF SNS;ITW!._f-FOL'Ol'NLLIUFR CLTE IR/GUOD.YY1 �OAIE itiN CdYYl I - W'CRAL LIAXLn-� , t4Cr. 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(•'CtRyf-PtlL_CYLIA4F ; 3 50G OC10 Di Dl CPIPT!GNUG U✓E"I.ON:I LOCAiI:,h5, YLn•CLfi. F:L1;LVSIoNn : ;Vt L: r EuwRl.LmVIT 1SPE CIAL YHO"SIC,•1$ T� -- -^- -----i iOFeratinTls Lra1T..1 tc Cei:r. :i-e aa„o;cy rental/ Set-up 6/1/07 9'ake-3uw:_ F/4/C'l I `I ifl.� + CERTIrICAfEHOLpFR --_W �_ CAPi ELI.tiIICN —i I — T.IYLORP SI,OJLD ANY Of UIi AC01F t5SCR'dL: PC! IC!PS ('F CAhCELLFO 132Fn-E 7HC a - RAIVI"� DAT[THER 1),!.155UIN4 INSURER W,LL ENOF.AVOR T7 MAIL 1O DAry WHIttEN NOr..CE TO T!IF CERTIFICATC HOl CLR NAAIL010 Tn6l EFT, BUT FAiLUPE TO (N):1:..riltALi. 1 Taylor. Prenort•atitin �19SOC- IL!PCSf IroCLGGATIOVCr•1:A9!Li 1'C�A4YKRi3L''O:I73;EIp4Uv4.iPSA75NTSOR 1 Taylor say rare 1 108 Bray Farm/ North Y1rmouthport !tS 02F75 Auq, Nkr& ACORn 25 I':JODUtl) ACORD CUI1QO!'.II NON T!-I '.F;:1rance RX NO. lbt?85-tY)914 USI South Coast 4/30/2007 1:29 PM PACE 2/003 Fax Servei - r. 0', �tJ E�12R C�1��'If=ICATE OF LIAI3ILITY INSURANCE: 04n0106 PRaouctR _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORmATIOR eclaltks•EP t ONLY AND CONFERS NO RKi1TTS UPON THE CERTIFCATE 1J31 Rental S P HOLDER. THIS L'tRTIF1CAfE DOE5 t1OT AMEND. EXTEND OR P.O. BOX 53310 I ALTER rHE COVERAGE AFFOMED BY THE POLICIES UELOYV. TEAM CA 92612-3310 INSURERS AFFORDIN3 C04ERAGE I\%W _._ ~-• - rNS:REP.A. Sr. F'eulFlpand Marivelnsuranca Chase Canopy CartTpurty. LLC 14wkrR 5 4 Nick)(* Lane INofackc-- Mattapolsett. MA 02730 14WREN0: ... •. THE P:UCI&i QF INSIWANLE'_ISIM:3(:Z4V tL:ILi �ZLV ftitJCD I IHE Ci SUFF3 NAIAEP A60VE Fox IFG /u.A-r �enl.�u ...v.K;.1,1 E + MIAf .°,£ kaSUE:.' OR Oft OTHER DOCUMENT r1CM PCSPECT ►P WNCH f4i CERrIFICn] ANY PEC'JIRD. E'YT. rt2W OR LYl.U1T1O% OF ANY CCMILtCT IMt N41#kA.10E AFF0i7UE4) •3Y THE rcttf:lS jest eb HEftE.IW M SUJJI:GT 11) AL. THE fEK%I5.DCLO310%;i MYUE'O%C•ITIUNS N SU'.H ]IAA.' 110(IAN PO_IC1EE. ACG`TEGAI E Lllt.TS StJU.-041'.A'r RLY£ GLEN REDt)W)13Y PAID CLADS. �TMLICV EF r�RiVL LY.Irs EULICY N_ uyUEN CAA !If�bPIYYI TYEE OP INSf:RANCT -_ -PAI11E1JrRAF1(`.NT��__+ F7PAELI1Ef6D:1�i .li..—__. _ !CFE0071A4,34 1071T)WOb EAOICr_wws�ct if1.000,0ao __. A ioCNEnALUA:LMY IO?/06!07 'CPC �.:LiY.F. (Arty mcfiN S1 aDyDaO X I Qu4ENC✓:.`l-CFriw: :.P34ITi' I _._._. I S, I-'XC CLAM 411E CCVR I t1i 1 .WED ErF (NN arw;l �—' I 4PEr7EGW•L •FCV IN111N_Y_ 31 0_70 M� �$2000OOOCj-- I GENFPA AGGNEGlTF — 1 P^ SS.00D 8O't•I ' CE_NC ALORE GATE L M T AWra G+Vt N' i _ _�--1-...�—_ L _ I X : Pot ICY i PRG 1 I GPJ91'80 9;q:.lE L41R IS I AUTOMODILL LuatJ(Y I ANY AUTO - -•_ 1 ALL ONIRO N1T C: i t �1 S�t'•,.Y�,fRY _ SCHE JU.EG 4AICS_- • FU.'ii,i•AJTCB e-. I ROD -A 11JURY S I (Po 4oraANI I.—: NOfI-!7M1NE: AUT!IS � I-�-••••_.— I -- 1 '. PRC�cR'r OJJ14iL l too 4wea71 -....� - I A1JTtit-44A•—FA A:`.DCNT ?S �GRA�LSADt1TY i OTHFAT�iN .A :J.".. S IAJTit CNtt M.'G l-i _.-•.^._ .• -• C;tC[SS 11ADIlTTT 1— OEOUC'rIDLE , `p�TENIRN _ •. I Wd/NENSCOIAPFNGnom AM ' 11ArL0VLrWuAD,L1(v nent Floater :1 Form _,•, EI CAI O!C%KrRF Ii'.i. S . MUM 01,TC r S H F^.:»rT.Wl .E1 i4Pt�.:YEa: S. I ___JEl�:ICEASF-aaLa_YL1Jn 11 iASB : D7106106 �0710E107 I 1 $800,000 Limit ,000 Deductible UTeCRtrnw OF OPCRAT10NStocan ovynn�i•' anw..LUSIpta AnIJLO eY ENDaNetNc!frlSPEQ:LP0.SYIEltkJS P,-oof of FOVara9U. "Fxcept 10 days wotice of CLTVv1,1ation tot ron•p2ymeTt. Re: Set-up on 06M1107 and Htl,t>doW o un OfitNW _- I1"Outa W(OFTHEADM 0E3CR®2D Pa1CLSSECAYMUO elfntE Tit'. nc'wnav Tenor Proaemttlon Aasotlatlon: DATe Tr ERrt1. TIIE fsaJwC WfUiER MILL tNVEa YUR TO4W .t(Lr DAE]NNrtrI V Taylor Bra/ Farm ' %an= rOME MImcX Arr HOLD CRN.fttS TUM ELEET aul FAJLURC TOO OSOSPAU 103 Bret FarNNcrtt: i IMPMENOCOUGAuaN CALMLTYEFANTIURD u.cwTHE wa,ReR113AULNTSM1 Yarmouth Port, MA Difi s--- w OTtl 'Utf.7 RCFglC(AI �TSV[ '.CORDYiSpJ111 0°« r�.'S419h07'Mt7�R19 AXLJQ tl ACGfIUCOFtYORATiO\I'7J3 IMPORTANT DOCUMENT Certifirate REGISTERED APPLICATION NUMBER F140.1 of f fame ISSUED BY 0CBOR. wousraies EVANSVILLE, INDIANA 47711 Roi!gtante MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have (or are inherently noninflammable) and were supplied to: 266675 CHASE CANOPY COMPANY 4 NICKrS LANE P 0 BOX 46 MATTAPOISETTE MA 027390406 Date of Manufacture 02/03/00 Order Number 310460 been flame-retardant treated Tc yvxa0M - 1 •I Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. The method of the FR chemical application is: Serial #: 8140100 (2) Description of Rem certified: CENT MID 40W X 20 VL W W Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Signed:..t1Z ame orp icator o lme Apaesistant Finish TENT DEPARTMENT —ANCHOR INDUSTRIES INC. F REGISTERED APPLICATION NUMBER F140.1 IMPORTANT DOCUMENT caft 9 of f fam ISSUED BY 1019! on • EVANSVILLE, INDIANA 47711 Re,65tante MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have (or are inherently noninflammable) and were supplied to: 266675 CHASE CANOPY COMPANY 4 NICKY'S LANE P O BOX 46 MATTAPOISETTE MA 027390406 Date of Manufacture 02/03100 Order Number 310460 beets flame-retardant treated 7c510�c�o4�-�, Certification Is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. The method of the FR chemical application is: Serial #: $140300 (t) Description of item certified: CENT END 4ow x 20 LO vL w w Flame Retardant Process Used Will Washing And Is Effective For The Signed* SNYDEB MM b0M PIM a nr r nsrr a Oza Name of Applicator of Flame Resistant Flnish Not Be Removed By Life Of The Fabric DEPARTMENT —ANCHOR INDUSTRIES INC. ., REGISTERED APPLICATION NUMBER F140.1 IMPORTANT DOCUMENT of ,Aare ISSUED BY CHOR. wousTaies EVANSMLLE, INDIANA 47711 Roi!gtanre MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have (or are inherently noninflammable) and were supplied to: 266675 CHASE CANOPY COMPANY 4 NICKY'S LANE P O BOX 46 MATTAPOISETTE MA 027390406 Date of Manufacture 0710m Order Nranber 310460 been flame-retardant treated 7z yvx-2oC -9 Y Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code, equal to exceeds NFPA 7019 CPA184, ULC 109. The method of the FR chemical application is: Serial #: $140200 (1) Description of Item certified: CENT END 4ow x 20 HO VL w w Flame Retardant Process Used Will Washing And Is Effective For The Signed- erne pp rcator o of Alame Resistant Finish Not Be Removed By L ife Of The Fabric 0 -� TENT DEPARTMENT —ANCHOR INDUSTRIES INC. of r TOWN OF YARMOUTH Building Department BUILDING _ _ _ • ..... , (508) 398-2231 ext.261 PERMIT NO :B-07-„79.. PERMIT • ISSUE DATE : • 4/13/2007 • ; PROPOSED USE APPLICANT Taylor -Bray Farts I JOB WEATHER CARD PERMIT TO • MISC./tent AT (LOCATION) 0108E RAY FARM RD NORTH ZONING DISTRIC RE0 SUBDIVISION MAP LOT BLOCK 1151.24 BUILDING IS T B ST l LOT SIZE temporary tent - duration: 7/27107 - 7129/07 REMARKS Bldg. Type: Residential 'E= USE GROUPC AREA (SO FT) EST COST ($ $0.00 PERMIT FEE OWNER rOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 1108 Bray Farm Road North [Yarmouth Port I MA 102675 INSPECTION RECORD Date Note Progress - Corrections and Remarks 10-16-67 -SrA0 CONTRACTOR LICENSE O PHONE 15083989407 FIELD COPY Inspector RECEIVED I APR 13 2007 EXPRESS BUILDING PEWWAM TOWN OF YMMOUITt— Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: OWNER: Q CLP'" NAME CONTRACTOR letj I Map: /< I I Parcel: dL1 I !!AQ•� rij 21 Pcrtnic -��//7; Nl IFaS�� Permit expires 6 months from issue date. i N X) 7', 28'-3`g-2z31 TEI. # To, 15a6 -3 9s'9YB7 TEI..# * Residential ❑ Commercial Est Cost of Construction S Home Improvement Contractor Lic. # Construction Supervisor Lie. # Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name. Worker's Comp. PoUcy# RECEIVE D Tent (Fite Retardant Certificate WORx 0 BE PE 0RME`D [__ APR 1.3 2007 Duration -7-Wood Stave Led ,F,4 -- f70,11-7YARMOUTH ❑Siding #of Squares OReplacement windows: # OlD GS HIGHWAY ❑ Replacement doors: # ❑ Re -roof- # of Square () Stripping old shingles* 'The debris will be disposed of at () going over layers of existing roof I declare under penalties of perjury that the statanen herein contained are true and correct to the best of my Imowledge and belief. I understand that airy false answer($) will be just cause for denial or on of my li andTor prosecution under MGL Ch. 269, Section 1. / Applicant's Signsaae: Date. 47/&3 0 7 Owners Signatrne (or attachment) Date:. Approved By: Date: Building Official (or designs) J Zoning District & Historical District3 Yes ❑ No Flood Plain Zone: es ❑ �No Water Resource Prote�c.t,*Di�strict• Within 100 IL ^ of Wctlands. ❑ Yes W "� �Y s ❑ No 3101 pDepartment of Industrial Accidents Office of Investigations 600 Washington Strut Boston, MA 02111 www.mrassgot+i/a s Workers' Compensation Insurance Afl)davit: Builders/Contradora/E]ectridanw7lumbers Aoolicant Information Please Print Legibly Are you as employer? Check the appropriate bow _ 'type of project (required): 1.0 I am a employer with 4. ❑ I am a general aontraceor and I 6• El New conatrnction cmploYtm (lid/ and/or part-tim4s 2.[31 am a sole proprietor or partner- - have bind the Bated on the attached abed = . 7. ❑Remodeling . ship and have no employ= These sub -contractors have S. ❑ Demolffin working forme in any capacity [No vvorkene camp. hm mee workers' comp. insurance. S. 0 We are a cmporatioa and its 9. (] Buildfa addition ofiicera have exercised their 10 0 Electrical npaus or additions 3. 0 I am a homeowner doing all work right of excmpdm per MGL I I.0 Plumbing repairs or addftiam myself: [No workers' comp. t:.152,11(4), and we have no 12.0 goof rgWn ." insaraace regairad.) t employees. [No weaken' 13.❑ Other . o�mp iaivama required ) t Homeopwoaa who mbmk d& f�dndt h4a ft dwy a dfa A wanee tan ouW& oo mad subralt a am affl&dt bons iwk tCa unck n tbd nbnek d& boot find dhebnd a oddit =d :bat dowbng do Homo of do zab•aorttnclon nod dwk waken' eonqL VW 7i Mbnrugm I am as anploya that Is provldfiea workers' eompeawedooa lnswraree fer my emplayem Below 6 tht pollq arkjob SNO brforraatlaw. Im>aanee CompaoyNatne Policy # or Self -Ins. Lit M Expiration Data Job Site Addnsa: MWStatc64: Attack a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to sewn coverage as required under Section 25A of MGL•c.152 can lead to the imposition oferiminal penalties of a fine up to $1,500.00 and/or one-year imprisonmen4 as well n civil penalties fa the fora of a STOP WORK ORDER and a fine ofup to $250.00 a day against the viablar. Be advised that a copy ofthis statement may be forwarded to de Office of Investigations of die DIA for insurance coverage verifi 2*m Ida hereby cero underthe pabrs card penalticr of perfwy that the Grforntdioa prvW*d above h true oncarreet Mr-1-TUM-L-1 ;1M�Jv O,fl?cld use only. Do runt write la th6 area ro be eonfpleted by clq or rows o,�'itelii City or Town: PermMucense 6 Issuing Authority (circle one): 1. Dowd of Health 2. Building Department 3. City/Towo Clerk 4. Electrkd Inspector S. Plumbing Inspector 6.Other Contact Person: Phoned: jInurinatiun auu iaa►7mt.a aava.avaLjL.+ Massachusetts General Laws chaps 152 requires all employers 10 provide wtmrken' compensation for ibex employees. Pursuant to this BMW!, an naployw is defined as "...every person in the service of snother under airy contract of Lire, or �hy ed, oral or wr" A ` An express ,, is defined as "an mdividUA Partners* avociaOM WTPon6m dr other legal entity, or any two or more and including the legal of the foregoing ags8� in a jgiat en�e~ representatives of s deceased employer, or the receiver or tntstee of an individual, partnership, association or other legal entity, employing employers. ; Aawever the owner of a dwelling house having nottmre than three apartments and wbo resides therein, or the occupant of the dwelling boost of another wbo empbys persons to do maintenance, oonatraction or repair work on such dwelling house or on the grounds or buMing appmunant ibau. shallnot because of such employment be deemed io be an employer." MGL chapter 15Z 42SC(6) also states that "every state or local licensing agency shall withhold the Issuance or renews, of a license or permit to operate a badness or to construct buildings In the commonwealth for any appUcast who bus not produced acceptable evidence of compliance witb the Insurance coverage required." - Additionally, MGL chapter 152,125C(7) states "Neither the commanwealdi nor any of its political ssbdivisions shall enter into any contract for the performance of public wort until acceptable evidence of compliance with the arsutrance requirements of" chapter have been presented to the arntracdng authority." Applicants Please fill out . the workers' compensation affibmt completely, by checking ibe boxes that apply to your situation sad, if necessary, supply sub-oantrackn(s) nan*sl address(es) and phone number(s) along with their certificate(:) of msurauce. Limited 13ab IrW Compsma (LLC) orLh=ted Liabr'kity Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation iasmance. If an LLC or UY does have . employes, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage Also be sure to dga and date the'aftidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidermts. Should you have airy questions regarding the law or if you are required to obtsin's workers' cooperation policy, please call the Department at the number listed below Self -insured companies sbould eater their self-insurance Haase mrmbirr on the appropriste king City or Tows Olficish _ Please be sore that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the appHcaaL Please be sure to ® in the permMicease m>mba which aril be used as a reference number. In addition, an applicant that must submit multiple permiNicere applicatiom in any given year, need only submit one affidavit indicating current pommy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or loan maybe provided to the applicant as proof that a valid affidavit is on file for fature permits or licenses. A new affidavit must be frilled out each year. When a home owner or citizen it obtaining a license oipamit not related to any business or commercial vcntUM (ice a dog license or permit to barn leaves etc.) said person is NOT required to complete this affidavit The Office of investigations would litre to thank you in advance far your cooperation and should you have any questions, please do not hesitate to giveIN a call. The Department's address, telepbone and fa: number: The Commonwealth ofMassachnsetts Department of Industrial Accidents Ofi3ce of Investigations t 600 Washington Street. Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1=877-MASSAFE ` Revised 5-26-W Fax # 617-727-7749 - www.mass.gov/dies APR.10.2007 2:430 NO. 769 P. 1 COMM ON?WE.A b H Or, N 55ACHUSBTTS . BARNSTABLE COUNTY CORRECTIONS FACILITY 6000 Sheriffs Place lioume,b4A. W SK ;Phome),508-563-4300 kTax)508463-4574 BCSO@bsheriffnet Sheziff James M. Camm,Ings Integrity,Professionalism Compassion & Teamwork RurH Facsimile Cover Letter ss 8F-R6-," To; )n}, DR W-w Fax: From: mil_ E NEIi Z- Subject: Ta111 r Date:-,wh16r1 Total Number Of Pages including cover letter: 0 Comments: FAX COLTER SHEET SIARNING THE INF03MMON CONTAMD IN THIS FAX MESSAGE IS INTENDED ONLY FOR THE PERSONAL AND CO\TMZ-N- TIAL USE OF THE RECIPIENTS NAMED ABOVEMUS U ESSAGE MAY BE A COMMUNICATION WMCHAS SUCH,IS PRIVILMED AND CONFIDM AL.IF TILE ROADER OF THIS MESSAGE IS NOT THE WIENDED RECIPE-T OR AN AGENT RESPONSIBLE FOR DELIVERING IT TO THE DnLN-DED RECIPIENTS,YOti ARE HEREBY NOTIFIED THAT YOU HAVE RECEIVED THE D0MIENT IN ERROE AND THAT ANY REVIEW, DISSEMINATION, OR COPYING OF THIS MES- SAGE IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US 1MIvIEDIA7ELY BY PHONE AND RETURN THE ORIGINAL TO US BY I� AM.THANK YOU. BARNSTABLE-BOURNE-BREWSTER-CHATHANI-DENMS-EASTHAM-FALMOUTH-HARWICH MASHPEE- ORLEANS-PROVINCETOWN-SANDWICH-TRURO-WHLLFLEET YAR�MOUTH APR.1C.2007 2:5BAY N0. 67;10 712 3 'P. . . ,�lp,V.. 4.4686 10:26A'i BCCf IMPORTANT DocUMENTmagummumma . Cert>if jests of Flame Resistance ISSUim SY pato of shipment ' "STRATION eemero4 1CATlON PON flUIIA �It Tont tdenit(IcMton EVANSVIu9, INDIANA 47725 p er»ia+ I121.4 MANUFACTUR£R6 of THE FINISHED TSNT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been ilame•retardant treated (or are Inherently noninflammobts) and were supplied to: 769E0 BARNSTABLE CaUNV CORREC11ONAL 9000 SHERIFF'S PLACE BOURNE MA01532 Certification is hereby made that: The articles described on this Certificate have been treated with aflame -retardant approved chemical and that the application of said chemical was done In conformance with California Fire Marshal Code. Ali fabric has been tested and passes NFPA 701.99, CPAs $4, ULC t09. Sepal0 U0110Q11) Doscriptton of Itsm e*rUfiods I@STATM =WX0 WH= VM Frame Retardant Used Washing And Is Effective Bo Removed For Thelife Of ?ie Fabric LJ � �u� LYITPi pY1S10H • ANCtIDA tDUYrA1FS NC. ..� e+e-jo_ci e_one- r-n jdoa9 eLV I I 80 00 RON (zSN--4! TOWN OF YARMOUTH Building DepartmentBUILDING ____ (508) 398-2231 ext.261PERMIT NO....67-10s3_: !Ia..; PERMIT ISSUE DATE 3/30/2007 _ : PROPOSED USE ..I ; ............................. APPLICANT-RobertJOB WEATHER CARD --------------------------- Carlson PERMIT TO AccessoryStructure; AT (LOCATION) 0108BRAY FARM RD NORTH ZONING DISTRI -40 RBldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24 BUILDING IS TO BE: CONST TYPE USE GROUP = LOT SIZE construct 12 x 16 sheep shed as per plans dated 03/29/07. REMARKS AREA (SO FT) I EST COST ($ $1,000.00 PERMIT FEE ($) OWNER tTOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146Route28 CONTRACTOR LICENSE 083857 Carlson, Robert 1146 Route 28 _ South Yarmouth MA 02664 5082942416 South Yarmouth I MA 102664 1 PHONE ISM982231 _ INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector W This Section for Office Use On Building Permit Number. Date Issued: = Signature: Building Official Date Certificate of Occupancy is is not required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: /08 SrayFAr 4 P-G,cb., C�ar►+�o l�or 12 Zoning Information: kffl C fsl�ep sheer Zoning District Proposed Use 1.3 Building Setbacks (ft) /( Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.O.L c. 40. S 54) Public Private 1.5 Flood Zone Information: -Comments:.,` ; - .. - ` 4 Zone: BFE: Section 2 Property Ownership/Authorized Agent - 2.1 Owner of Record: J� /own o-,� Af'I.vcou r��l Name print) Mailing Address OUJ ln U Signature Telephone Fax E-mat 2.2 Authorized Agent: D0r7o�/i re !03 , �f i:Jo • o rf Nam (print) sos-38S- g Mailin Address Mctsz d ,l�s� Sig re ele n �+q e-mail /► L�f flai'mr d s Section 3 - Const uction Services 3.1 Icensed struction Supervisor: oD?a /,raw License Number Address �,/ /Y%t� 3 / %(/>�! L Expiration Date . -f , _ O� Si r Telephone Fax E-mail s-o� � y2 yip . 3.2 - Registered Home Improvement Contractor , . Company Name Registration Number Address Expiration Date . Signature Telephone Fax E-mail - I „f9 nv;:n Section 4 = Workers' Compensation Insurance Affidavit (M.G.L c.152 S 25C'(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result In the denial of the issuance of the building permit., t Signed Affidavit Attached Yes .......... No .......... A Section 5.- Description of Proposed Work (check all applicable) New Construction No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. UYType . ,,-4— Demolition Other Specify: Brief Description of Proposed Work - do nsfgjc /2' JC .16 ' 6`1Qe Shed Costs Estimated Cost (Dollars) to be Check Below completed by permit applicant ❑ Conservation -Commission Fling (if applicable) WOld Kings Highway & Historical Commission approval (if applicable) be Completed When for Building Permit ' Section 6 - Estimated Construction Item 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses 6 edc ions) Section 7a = Owner Authorization -To Owner's Agent or Contractor Applies as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Ownee(A_ uthorized Age t Declaration I, '68 n %' e L�% � , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate; to the best of my knowledge and belief. Signed under the pains and penalties of perjury. /Dan M Tn `�jre Print name Signature of Own ent Date 9-15-99 2of2 PLEASE PRINT: Job Location: TOWN OF YARM-OUTH BUILDING ,DEPARTMENT CONSTRUCTION SUPERVISOR FORM rob Village Owner of PropertyLIVE 1( —u "40,/ &J ' Construction Sttpervisor:96Ct.,/ 06�/5 Name License No. Phone No. Address: 3 Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully,.iolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. ,Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 . Yes ❑ No. ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owners Agent Owner ❑ Agent Signature: Building Official Approval: r For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: Est. Cost_ Address of Work 168 Owner Name: -93 Date of Permit Application: 3 /S 01 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name �L\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwmmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organ tmtion/Individual): Address: City/State/Zip:_ Phone.#: Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also fin out the section below showing their workers' compensation policy inforrnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and fob site information. Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above Is true and correct Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person' Phone #' Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for'their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the alHdavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitnicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or perndt to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner —occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building Wrmit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch 142. Yes ❑ No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ h:homeownrlicex emp TOWN -OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH NIASSACHUS=02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION' DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ✓1 OB Tf� rd-01" 910C Work Address is to be disposed of at the following location: / Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. .54 :5P /0 7 Signature of 4plicant 1, Date Permit No. Old King's Highway Regional Historic District Committee In the Town of Yarmouth for a APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: Exterior Building Construction: C New Building 0 Addition 0 Alteration Indicate type of building: 0 House 0 Garage 0 Commercial 00ther_ N 2. Exterior Painting: ❑ a —I 3. Signs or Billboards: 0 New Sign 0 Existing Sign ❑ Repainting existing sign m C 4. Structure: 0 Fence 0 Wall ❑ Flagpole 0 Other m t Z ?� TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK /OS bnzf Foi-I-N ) ,1JO.ASSESSORS MAPz ;7� OWNER 10"J A ASSESSORS LOT NO. HOME ADDRESS TELEPHONE NO. GENT R CONTRACTOR ( - E/1 '76�1 re TELEPHONE No6-oa ADDRESS/ O 3 3r� � rho /ed. lV o . t'aa-nvl a cl-1 �4 a t-'fz1P CODE OZ 6 7 5 USE ATTACHED SHEET (PAGE tt3) IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars ofwork to be done Including materials to be used In case ofsig?m give locations oferisting signs and proposed locations of new signs. (Attach additional sheet, if necessary). mild 5�eeP 51led U61til z'x-4' Cons�r-uc�ron, r e-cf eeda-r rao-iOt WA;-Ie cedar sly Ong !es o n ,5 refs✓ �ls. eo l a n c et'f r-e.c( -fi•- ivv- bocci 5 Signed 1 —a e Date r-e'6 . t z 120 a 7 • Owner-Contracto Agent is aware t at a Permit is required from epartmea • All new construction will be subject to inspection by OKH Inspect 0 �I E D • It is required that OKH approved (with BD stamp) plans areava a on site for site for ttee rr and final inspections. I MAR 081007 Sonce below for Committee use only. Date This Certificate is hereby Check Dat .✓� By APPROVED IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act DISAPPROVED 0 PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth, MA 02664 :. sy SPECIFICATION SHEET ARMOUTH OKHC • Provide color chips and attach where necessary. • NewHouse. Provide Landscape Plan. On Site Plan show exterior lighting and eleatric meter. Address j o8 BF"d4 FtiM Description of proposed work: ;5n erg,2 6he- 6 Z 'X I & `) FOUNDATION (18" MAX. EXPOSED): CONCRE'I DRIVEWAY: Goncrc, WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): r SIDING TYPE & MATERIAL: Ev ,4e- cedar -6At n j %e-s COLOR CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR - RO F MMA/TERIAL: PITCH (7/12 MIN.)- . MAX- EXP. -- (o. r - - -.- _ - -•-- - _ -. —COLOR COLOR r�L�a..- l ea-4 WINDOWS ( GRILLES REQUIRED ) INDICATE SIZES IF NOT LISTED ON VATIONS: COLOR DOORS �OTHER) (INDICA AND STYLE IF NOT LISTED ON ELEVATIONS): TRIM: (ALL WINDOWS & DOORS TRIhQ64ED WITH IX4 MATERIAL OF TRIM: (WOOD INYL, ALUMWM SHUTTERS (WOODNINYL) (PANELEDILOUVERED) GUTTERS (WOOD/ALUNIINUM): GARAGE DOORS: SIZE & STYLE: STORM WINDOWS & DOORS: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE COLOR COLOR Co`blc" 4 r COLOR COLOR COLOR COLOR COLOR -- - -- WOOD DECK: SIZE: COLOR: - WOOD FENCING (MAX. HEIGHT 6): STYLE: 9ECOLOR. LOR: (SHOW LAYOUT & RUNNING FOOTAGE ON SfT PLAN � � RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPRO(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLANSIGNS: (indicate size, style, colors) SIGN POST: (indicate size, style, color) COLOR Additional Information r; 7A6 �� f t a / IL \ �/ t � t � a pa5f�re t ex r 5tm ► ' chicken / � t s cep A/ :Shed / o'/ 0 off s Deft r � ` t r i t ,pet --,+ore- APPR Vp ED MAR 08 1001 flof Plan 6how/n9 propo�d sheep 5hed af" Tau/or-£ray Farm Varrnov�h Porgy Feb./z zoo? Scale: 1'=50' .. • i 77- M ZD ch C) 0 00 M) C=31 C= 2• or FA F,eolq-r 6C,96-6: /Z I # 48 TOWN OF DENNIS J CREEK GARDEN O 10MoFYArAM rH -4S .MAC 04 flat 1 9� � 4! 03 108 am 3SA 110 Al AC q 107 1l' .70AC 1 3s fw► ';Vol C 114 7e AC v c..� 7 too MAC . 3 �r 11e 34AC 11e 17 0.e7AC AZ O A �,/ D D mAC "W 8 Ap 1 A;. lAR200 7 TVA '4b ��tr• g HIGH A 11_ �O w- 01. ING �^", .y O�AC b .� C sc v,o93 Ao RO7�„ a7AC , e1Ac 10 TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 exL261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-404 Applicant Name: Robert Carlson Applicant Phone: 5082942416 Building Location: 0108 BRAY FARM RD NORTH Owner's Name: TOWN OF YARMOUTH Owner's Addres 1146 Route 28 South Yarmouth MA 02664 Owner's Telephone: (508) 398-2231 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 3/23/2007 Issue Date: Expiration Date , Comments: Map/Lot: 151.24 construct 12 x 16 sheep shed nez 3 Z'D7 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: DATE: DATE: DATE: DATE: DATE: DATE: PLEASE NOTE WA: N/A: WA: N/A: WA: WA: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 3/27/2007 Old King's Highway Regional Historic District Committee In the Town of Yarmouth for a \® 4 CERTIFICATE OF APPROPRIATENESS Application is hereby made In triplicate, for the Issuance of a Certificate of Appropriateness, under - Section 6 of Chapter 4709 Acts and Resolves of Massachuset1s,1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: y-� 1. Exterior Building Coostraction: C New Building 0 Addition ❑ Alteration 4 ` Indicate type of bngdlog: 0 House 0 Garage 0 Commercial OOther Oh i ckel i �rpo 'D 1 2. E:terlor Paladng. ❑ (-1-1 No -� 3. Signs or Billboards: 0 New Sip ❑ Existing Sign 0 Repainting exbtiag sign l .� � 0 4. Strectore: 0 Fence 0 Wall 0 Flagpole ❑ Other m N M _ C) TYPE OR PRINT LEGIBLY DATE M/lr� Z� ZOFI�Io ADDRESS OF PROPOSEDWORK/0 P 132-q FarAl Rd- Ald. ASSESSORS MAP NO. / SI OWNER //fit c� /I U -t �C�r ry► oy`{ Z� ASSESSORS LOT NO. HOME ADDRESS TELEPHONE NO. AGENT OR CONTRACTOR TR ,=� TELEPHONE NO SOP -.38 S - V40 rJ CODE OZ 675 USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK Gtvs all particulms ofwork to be drone Mcluding materials to ' be rued In case of signs. give locations of cs 1ft signs and proposed locations ojnew signs. (Attach additional 21 9by,ED � �� coop YARMOUTH COMMMEE ; ! OKHRD 1 cie,,.a ✓ ::.- �=Et fib ---- Span below for Committee use only, Received by OKHC ' Q Date This Certificate (s)?ere Date Chect t i ey '' APPROVED 0 IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided In the Act DISAPPROVED 0 PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall,1146 Route 28. S. Yarmouth, MA 02664 _,SPECIFICATION SHEET--(YARMOUTH OKHC) • Please fill out the form in its entirety and make 2 copies for a total of 3 • Providing color chips where necessary and attach, to all 3 copies • On Site Plan for New House: Indicate landscaping, exterior lighting and electric meter ADDRESS: /Ob l3= F44K )U, IU6�- FOUNDATION (18" MAX. EXPOSED): CONCRETE/OTHER DRIVEWAY: WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): by 101►ce0 6`ITO"3 0 Y NT/\ 1p wAife_ cec6z_r diIII g fe-6 CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) ROOF MATERIAL: PITCH (7/12 MIN.) /'eo d c_,a_da_r Snt l f es MAX. EXP. I WINDOWS (GRILLES REQUIRED) (WOOD/OTHER) (INDICATE SIZES IF NOT LISTED ON ELEVATIONS): (3) Z& to x 24 DOORS (WOOD/OTHER) (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): 3-o>C G=G TRIM: (ALL WINDOWS & DOORS TRIMMED WITH 1X4 / IX5) MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM) C.JCS o d COLOR: /1 4,-fu ra,i COLOR: COLOR: n 4a'4 r4J COLOR: L' 1dn ' re- c{ COLOR: Co (on i cam/ re- d SHUTTERS (WOODNINYL) (PANELED/LOWERED) COLOR: GUTTERS (WOOD/ALUMINUM): COLOR: GARAGE DOORS: SIZE & STYLE: COLOR: STORM WINDOWS & DOORS: COLOR: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: COLOR: / WOOD DECK: SIZE: qLOR� y WOOD FENCING (MAX. HEIGHT 6j: STYLE: COLOR& (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) rn ra oN 7 RETAINING WALL: (P.T. OR FIELDSTONE - CONCRETE INAPPROPRIATE) m r O C (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) ►� 0 Rl --! �_ co co SIGNS: (indicate size, style, colors) COLOR: SIGN POST: (indicate size, style, color) "'�'"""""°"'��°" ""�� "r�•.,•u.1COLOR: OXHND 2 �4r1f.J).ya ^ri`M�,aT'ly �'�S'IL'f1C91 RiFIRVt:K� .+ 9'G -r-�-Y"t i - .,.1 T I. I, II jl.11�l lllll l 1�t f 'll'�! �. 4 5'6• DTI-j I t I_ I I 1 f(' � ; IrEFT i l j l l Frl I�7T 1__I II.1�r- f1 flj.i--I�--j _•_ T —T i j ICC T`i 1- ,I A f I' I'T-r I 1 , I I it u l l rT ! q rrlt-rT' I'1 -RIGHT . t•J N rn o z� ' R r.CO Ltiti.... 1 Ors}irp i � REf , 5160 IV CI �� -`6CALE '14"= 1' C.H1C9C-A1* COOP I L 1 il, L I FR- 0 AJ -r I. L 4- IT L J I I-T r -III FF T-T - s Yi, Ike RE4p- l"I C-DO ) M m m 0 m C) co 2;z 'AR)VIO Appl?OVED UrH Col"11177 . ox1jRo EE 6 fto 11 � 5CA1 .Po9 1 � �, f Pasture 4- f J i \ � exi3-/in chrcken / pen Shed �`x •mot` coop /DI sheep / er��tin9 � pen chrokcn :coop / 4 00 ! a -Road. - - m r— C co i P/of F/W7 6howin9 propoSedychrckea coo Taylor- 6raY Farm pFFF.u:ri1 yamoufh Part' s YARh10UTH COMA+11TfEE MatZh Z7, 2006 5calc: / = 60, Mau ass Regional Historic District Committee Old vines Highway egi t in the Torn of Yarmouth for a CERTIFICATE OF APPROPRIATENESS Application to hereby made in triplicate, for the Issuance of a Certificate of Appropriateness, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: t. Exterior Balldiag Construction: ❑ New Baihting Indicate type of building: ❑ Hone 0 Garage ❑ Addition 0 Akeradom r 0 Commercial OOther Gh t aketi C°DOP, 2. Exterior Painting: ❑ 3. Signs or Blliboards: ❑ New Sign ❑ EA dlog Sign ❑ Repaindag axhitiug slgn rn O O 4. Structure: ❑ Fence Wall 0 Flagpole ❑ Other -� `ram' TYPE OR PR)7VT LEGIBLY M N DATE a j'g j ' Zg r7)90 . TJ S %� ADDRESS OF PROPOSEDWORK490 Per : �o Rd. / JO. ASSESSORS MAP NO. OWNER /�oJ/t U -7- �G -f— oyY'lt �FGu�I ASSESSORS LOT NO. Z'`j • I HOME ADDRESS TELEPHONE NO. AGENT OR CONTRACTOR 7'R FF PA TELEPHONE NO 508 — 38 57- 940 % CODE OZ 675 USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK: Gtve all particulars ofa+ork to be done tneladlrtg materials to be used In can of signs, give locations ofcxirttng signs and propared locations ofnew signs. (Attach additional WVED j nY) i YARMOUTH COMMITTEE li C;Gt c lu�v co610 1 - /{nJ OKHRD 1 APPROVED a IMPORTANT: If Certificate 6 approved, is subject to the 10 day appeal period provided In the DISAPPROVED ❑ PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall.1146 Route 28, S. Yarmouth, MA 02664 SPECIFICATION SHEET (YARMOUTH OKHC) • Please fill out the form in its entirety and make 2 copies for a total of 3 • Providing color chips where necessary and attach to all 3 copies • On Site Plan for New House: Indicate landscaping, exterior lighting and electric meter ADDRESS: i o b O r& y ha,,ui , ,Vp r-1 FOUNDATION (IS- MAX. EXPOSED): CONCRETE/OTHER DRIVEWAY: WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): SIDING TYPE & MATERIAL: &, j t le- C ea,r 7-41 r 11 CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) ROOF MATERIAL: PITCH MAX IN.) red WINDOWS (GRILLES REQUIRED) (WOOD/OTHER) (INDICATE SIZES IF NOT LISTED ON ELEVATIONS): (3)0a10x Z44 DOORS (WOOD/OTHER) (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): 3-o k G- G TRIM: (ALL WINDOWS & DOORS TRIMMED WITH IX4 / IX5) MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM) t,�u o cl SHUTTERS (WOODNINYL) (PANELED/LOUVERED) GUTTERS (WOOD/ALUMINUM): GARAGE DOORS: SIZE & STYLE: STORM WINDOWS & DOORS: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: WOOD DECK: SIZE: COLOR: 1I .*4w r aJ COLOR: / COLOR: ACc.4 i'Il COLOR: C o wn ' a,f rc� c{ COLOR: c_o (on r c--% re- d COLOR: COLOR: COLOR: COLOR: COLOR: COLOR: WOOD FENCING (MAX. HEIGHT 6): STYLE: Cg4QR: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) N m RETAINING WALL: (P.T. OR FIELDSTONE - CONCRETE INAPPROPRIATE) �v (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) m SIGNS: (indicate size, style, colors) SIGN POST: (indicate sUe, style, color) N ._COLOR: 'O COLOR: APPROVED ' I YARMOUTH COMMITTEE tI�7'Mwa..11�M�M�+lk�lM� /� 2 CHICKEN, . coop I I I L 'J I C L J F . Fpo"-r 9 E.,q P- v-n O rn CI Fn C) 'T APPROVED YARAJOUTH C( )flhllTTEE CKHRO 6C,11- 6 : A - -' 1 AFp co CoAlk11 trEOKyEpjE I11L;1.1.._I1 11 J -I I -IT C I T- I I f 11 1 I I I I f II I III J2 / G P _r YARMOUTH TOWN CLERK 701S APR 20 N1 2- 09 YJ RECEIVED t � exia�ir7 chicken / b pen �t / J� Proposed shel /�l .Z. chicken •,? ; coop --sheep / � or erlo•I-1n9 pen chr¢ken �� :coop 4� / ref r fill r e4sfure f 1 r APPROVED / �07Coy`�� YARMOUTH COMMITTEE / f . Plan OXHkD 6hocain9 Proposed chicken..�...- • at - ', Ta. plot- L'�racj Farr year-mouf-h Port /naah Z7, w06 5calc: /• = 50' Old King's Highway Regional Historic District Committee in the Town of Yarmouth for a APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: "' 1. Exterior Building Construction: g New Building ❑ Addition ❑ Alteration m 8 O D Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑Other r1 a 2. Exterior Painting: ❑ m co O 3. Signs or Billboards•. ❑ New Sign ❑ Existing Sigu ❑ Repainting existing sign < (— C m —I 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other t"t Z) _ N W TYPE ORPRINTLEGIBLY DATE Feb . /Z zoe % ADDRESS OF PROPOSED WORK /O8 aN t Rel- lQO.ASSESSORS MAP NO. 151 OWNER 10t.0n o-� (�ICvr-Nitpcl-r-t^n ASSESSORSLOTNO. HOME ADDRESS TELEPHONE NO. GENT R CONTRACTOR 4,1>4 M e Q7 44 re TELEPHONE N06-00 C/4 R, AZIP CODE OZ 6 -75 USE ATTACHED SHEET (PAGE #3) IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars ofwork to be done including materials to be used to case ofsigns, give locations ofesisting signs and proposed locations ofnew signs. (Attach additional shcet, if necessary). &U dd 5leeP 5A&-d urinal Z'x 4' ac77 �7-uc�ron, reef e-eda-r >-ao-Pt WA&-f e ec t e'n (e f red -6-ir�c boa-rd'--' Signed 01 ` -Z e�27 Date r:✓6 . t z 0 a • Owner-Contracto Agent is aware t at a Permit is required from the BuildingDe artmeta • All new construct on will be subject to inspection by OKH Inspector. q P P R 6efi E • It is required that OKH approved (with BD stamp) plans are availab tte�fort ram and final inspections. Spam below for Committee use only. MAR 8 2007 Received by OKHC YARMOUTH Date This Certificate is herebt,,c-t OLD KING'S HIGH1l1 Check Date✓� By APPROVED IMPORTANT: if Certificate is approved, approval is subject to the 10 day appeal period provided in the Act DISAPPROVED ❑ PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth, MA 02664 7A411f f FIELD COPY BUILDING `c S-03- oe-7 .71 0z PERMIT *:. DATE July 26, 2002 PERMIT NO..3-03-087 APPLICANT Christopher Lee - ADDRESS 85 Abells Rd WY 02673 080884 --I INO.) ISTREET) ICONTR'S LICENSE) PERMITTO ALTERATIONS I_) STORY NUMBER or J DWELLING UNITS i (TYPE OF IMPROVEMENT) NO. - (PROPOSED USE) AT (LOCATION) 96 Rrny Farm Rd Nnrth — YPT' 02675 DISTRICT R40 ZONING (NO.1 (STREET) 'a BETWEEN AND m (CROSS STREET) (CROSS STREET) m m SUBDIVISION �M 151-24 LOT_ U O BUILDING IS TO BE FT. WIDE BY I FT. LONG BY LOT BLOCK SIZE m FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION E) fTO TYPE SR USE GROUP Ell BASEMENT WALLS OR FOUNDATION _ - (TYPE) O REMARKS: Repairs to 2nd floor -floor joists - addition of staircase as per plans dated 7-19-02 AREA OR r I PERMIT VOLUME ESTIMATED COST' $ _2000.00 FEE $75-00 (CUBIC/SQUARE FEET) 1 OWNER Town of Yarmouth ADDRESS 1146 Rt 28 Bi 02664 \ BBYILDING DEPT. INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR A► r� TOWN OF YARMOUTH Building Department BUILDING 10�e _ _ _ _ _ , (508) 398-2231 ext.261 PERMIT NO '_ B-03-087 " ISSUE DATE :_ _ 7/30102 : PROPOSED USE :::::::: PERMIT. �. APPLICANT Town OFYARMOUTH"""""""""""'" : JOB WEATHER CARD ADDRESS :1146 Route 28 PERMTTTO Alterations ......................................... AT (LOCATION) 00096BRAY FARM RD N (.108) ZONING DISTRICT R-40 SUBDIVISION MAP LOT BLOCK 1151.24 1 BUILDING IS TO BE LOT SIZE I CONST TYPE 5"B removal of 2nd story floor joists, build stairway to 2nd floor REMARKS AREA (SO FT) EST COST ($ $2,000.00 PERMIT FEE OWNER TOWN OFYARMOUTH ADDRESS 11146Route28 BUILDING DEPT BY USE GROUP R-4 CONTR'S 080884 LICENSE O CONTR'S NAME Lee, Chris THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBWC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE REQUIRED FOR ELECTRICAL WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBINGIGAS AND REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS 1 1 1J 2 2 � r f 2 3 OTH 2. 1 2 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTORS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE. X X 1( ?f 9- 15-99 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department ] 146 Route 28 • Yarmouth, MA 02664A492 ' Tel: (508) 39g-2231 x261 • Fax: (508) 395-2365 •'3 QQ Pranninafl&0 .F- r,.cw... lF e �2� Akessdrsb Information` z _,yf ryjf, ' H.-J.3'+2c Fermlt No.d�a 4 Plan Type— ----- --^--� sMap L r' ,tor= ' Map, Y Permd Fee- $ � S �� „-> �t s Endorsement t6 f �- - s a 4x �r ��* * ova r, `� �"�_ � lvew •. wY �S' • i � Y � s% ✓ RecardinDate P -. -"*r 1 f � R s^a sc Deposit Rec'd - ,p,.— -Det 9 -.f 14 Properly Dimensrotts � r 'het 4FfiisSecfiori rd biriceUse bn ,' w .` Buildin P_6rmit'Numbet u �. k Dafe [ssuEtid_ �� .,_ _ Signature CerTdlcate of Occupancy - wading ofraar Section 1 °='Site:lfirffd7ftati6nA-Use Group: R-4 ' , -Type: 5-B ; . ; : ; t ' .d'y = a '• . , t ; :; 1.1 Property Address: �Q`I 12 Zoning Information: Ae_M66fb44 QC ?_ &l 0-762S_ Zoning District Proposed Use 1.3 Building Setbacks (ftA.7 Front Yard Sl aids Rear Yard Required Provided Required Provided Required Provided 0f 0f a0` 1.4 Water Supply (M.G.L c. 40. S 541 . 1.6 Flo ZoneTnfohT1itf r` , t'omments y r y =r•-J sx Public Private `-6. y �� ��. `^ r.+.v! fr,r�; i ♦ t-}. s M � rid-_ . Section2'_. ropertyOwnership/A6thoriied'Agt of 2.1 Ovmer of Record U . 1j iA�00 Na Signature ` Telephone , 2.2 tthho�rized Agent: I �+ Name (print) Mailing Address V ature Telephone Section ='Con§traction Services: 3.1 Licensed Constructi9n Supervisor. Not Applicable Elt / r .!� 14? License Number O Q A dress Expiration Date (- Signature Tbtephone 3.2 Registered Home-.Tmprovernent=_Contractor:= Company Name Not Applicable ❑ Address _ License Number Expiration Date Signature Telephone oe 1 of 2 OVER • 1 - 1 SeirfCoEr?`"liioik'exs"isoRiiYsafioi�IrisittalaedavitT(IZ F �6 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure ' to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... . • [Accessory ecttotl�d"scnpifa ew Construction ❑ No. of Bedrooms No. of Bathrooms isting Bldg. Repairs) Alterations Addition ❑ Bldg. Ej Type 64-24 Demolition Other Specify: Brief Description of Proposed Work: J d�IMAW 5e14 C r I r Jo S Item Estimated Cost (Dollars) to be Check Below completed by perii kapplicant 1. Building 2. Electrical ❑ Conservation -Commission Filing 3. Plumbing / Gas ` / (if applicable) 4. Mechanical (HVAC) jam' Old Kngs Highway & Historical 5. Fire Protection "`��� • Commission approval 6. Total = (1 + 2 + 3 + 4 + 5) (if applicable) 7. Total Square Ft. (new houses a addfions) ,�,t• ......, 0vme s�[gellter"s�toi' *ip# Ites'�oBohttngp>se L , as owner of the subject property - ._• hereby authorize if n� 6�_ p to act on MY behalf, i all (natters relative to work aut orized by this building permit application, tore of owner — �`- fla. • Date I• ���� , as Owner/Author¢edAgent hereby declare that the statements and information on the foregoing application are true and accurate, - to the best of my,knowledge and belief. Signed under the pains and penalties of perjury. Print name Signature of Owner gent Date o^R� r ��Y PLEASEPRIN, job Location: Owner of Pro] TOWN OF YARMO UTH BUILDING DEPART..MENT CONSTRUCTION SUPERVISOR FORM Construction Supervisor. Name License No. Address: Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawi ngs as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration. repair, removal or demolition involving the structural elements of building and structures onlypursuant to the state building code and all other. applicable laws of the commonwealth, even though he, the license holder, is not'the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.I5.2 or2.15.3 orany other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction,* reconstniction. alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longersupennsingsaid persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The'license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the riles and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ,� No ❑ . If you ha4 checked Ls-, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAI R: I am -aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: c The Commonwealth of Massachusetts Department of Industrial accidents 0111ce o1 /Westlfftl/iis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Anolicant information: PfeascFRiRTT�ds'Idtc 1 am a homeowner performing all work myself. 1 am'a sale proprietor and have no one working in any capacity I am an employer pro%iding workers', compensation for my employees working on this job. eompanyname IOWYI 1�Ci'171t7K1 /l address insurance ro_ policy N lam a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below• %%ho have the following workers' compensation polices: address' city* phone N: insurance rn polier•N . address: iity: phone N- Insurance to, - - - - -- 11011cyN - a Failure to secure coverage as required under Section 25A of MGL 152 eta lead to the imposition of criminal penalties of a fine up to 5IrS0o.00 and/or out years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a Rue of S100.00 a day against me, 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. t do -hereby certi nder the pains penalties f perjury that the Information provided above is true and eonect �Signatuie ate `Print name P l� .J(J��ie, ,— ofricial use only do not w rite in this area to be completed by city or town official city or town: YARHOUTIJ _ permitnicense N nBuilding Department p1.1censing Board check if immediate response h required 261 OSelectmen's Office contact person: pHealth Department phoned/:_ (508) 398-2231 est. r7lOther lr�nsd 7•145 ►JAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. as quoted from the "law", an employee is defined as every person in the service of another under any . contract of hire. express or implied. oral or written. An enrphurer is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise. and including the legal representatives of deceased employer. or the receiver or trustee of an individual , partnership. association'or other legal entity; employing employees.`. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance. construction or repair work on'such dwelling house or on the Lrounds or building_ appurtenant thereto shall not because of such employment be deemed to be an employer. `IGL chapter 152 section 25 also states that every state or local licensing agency'shall withhold the issuance or ' renewal of a Iicense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance cobei-age required. Additionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and suppl Ing company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial `Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by -mail or FAX unless other arrangements have been made. The Off ice of Investigations would like to thank you in advance for you cooperation and. should you have any questions. .please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents @MCC If Iatrost11391113 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or375 r 1 g'� e O PLEASE PRIM: DATE: JOB LOCATION: 4-hHOMEOWNER" TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 eat. 260 NAME PRESENT MAILING ADDRESS HOMEOWNER LICENSE E}ETION OF TOWN PHONE WORKPHONE CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Persons) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two f nnily attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. Theundersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements ofMGL Ch.142. YS01:%P' No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ , OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 0 Agent 0 For Office Use Only j Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requiress that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any preexisting owner -occupied building containing at least one but not more than four dwelling units or strumres which are adjacent to such residua or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: ' Est. Cost ty Address of Work Owner Name: Date ofPermit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded bylaw Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. Signed under penalties of perjury: I hereby apply for a permit as the agent o owner. Z e ntractor N OR: Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name TOWN OF YARMOUTH 1146ROUTE23 SOUTHYARMOLTTH MASSACHUSgl-!'S026644451' Telephone (508) 398-2231, Ezt. 261 — Fax (508) 398.2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUM= F.f.FI'[4`Ar GAS Piu=G SIGH Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 11I.5, I hereby, certify that the debris resulting from the proposed work/demolition to be conducted at;%i. ' workAddrm r is tb be disposed of at the following location:pt- Said disposal site shall be a Iicensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Z_ Si Applicant Date Permit No. 0 SUBMTITAL REQUIREMENTS / CHECK LIST FOR BUILDING PERMITS New Structures 1. Application signed by the owner and owner's authorized representative / construction. . supervisor. Application shall include: Construction Supervisor's License, Worker's Comp. Affidavit / Certificates, Home Improvement Affidavit (all applications except new homes). 2. Six proposed site plans, stamped by a Mass. Registered Professional Land Surveyor, showing all boundaries, proposed setbacks, existing & proposed grades / contours, proposed location of structure(s), parking, curb cuts, drainage, impervious cover calculations (when applicable), flood zone and Title V design and any other zoning related details deemed necessary. 3. Three sets of complete construction plans, including a complete structural cross section, floor plans, use ofrooms, dimensions, window & door schedule, HVAC details — electrical, phunbing & mechanical plans are also required for commercial & multi -family (3 units or more) structures. 4. Flood zone applicability — Compliance with Section 3107 of the -State Building Code — Elevadon orfood proofing certificates (whichever is applicable), shall hesubmittedprior to the issuance of a certificate of occupancy. 5. Plans shall be reviewed by the following departments: Health, Engineering, Fire & Conservation (when applicable). The Building Department will forward. 6. Old Kings Highway & Historical Commission (when applicable). 7. Mass. DPW approval for State Highway curb cut and access ways. S. Construction control affidavits for, all projects to be constructed or altered under the provisions of Section 116 ofthe State Building Code. Buildings: containing 35,000 cubic feet ormore. One & two family structures are exempt; except certified designs may be required for unusual structural circumstances. Section 3107 of the Building Code requires certified plans for new and substantially improved structures in flood zones. Additions 1. Same as above, except the blank generic `Plot Plan' available from the Building Department may be used for one & two family structures when setbacks are not marginal. 2. Flood zone applicability — When the value of improvements equals or exceeds 50% of the structure value (substantial improvements). Alterations 1. Same as above, except existing & proposed conditions shall also be shown on the plans. NO NVORK IS TO COMMENCE UNTIL THE BUILDING PERMIT HAS BEEN ISSUED. Filing a building permit application does not imply approval and should not be construed as permission to begin work. INSPECTION SCHEDULE NEW CONSTRUCTION, ADDPITONS & ALTERATIONS The receipt ofa building permit is not the end of the permit process, but rather the beginning. The building permit holder is responsible for arranging the required inspections before proceeding with additional work. Failure to do so may result in having to expose concealed work through the partial or complete removal ofsome building elements, causing you delay and unnecessary expense. It is imperative that you arrange for the following inspections by either calling 508-398- 2231, extension 261, or make a personal request at our office at least 48 hours in advance: FOUNDATION • After certified 'as built' site plans have been submitted • Before concrete floor is poured • After perimeter drain has been installed • Before backfill • Before first deck is constructed • After damp proofing • After certified flood zone elevations have been submitted (when applicable) Note: When proposed plans specify re -enforcement rod installation or other unique design criteria you are required to call for an inspection prior to pouring the concrete. In some cases a. separate inspection may be required for a strata/soil or footing inspection. FRAME • After rough electrical, plumbing & gas approvals have been made • Before insulation • After being made tight to the weather FIREPLACE / CHIMNEY • When smoke chamber is complete • When chimney is complete (may be inspected with frame) • Final INSULATION • • After building envelope is completely insulated FINAL • After all other inspections have .been approved • After electrical, plumbing, gas & fire inspections have been approved After all applicable historical applications have been completed n Building Site Location: Proposed Improvement: .TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMTI'I'IAL SHEET No: 15 f Lot No: Address: 7o u Te1.NO291 ZZ3) Date Filed: -72?xl The Building Department wi4e responsible for assisting the applicant by dispatching your plans and or application to the following 'applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT. Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc -HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIREDEPARTMENT: Determines Compliance to State and Town Requirements for Personal ----------------------------------------------------- Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ...... -........................... --............................................................. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A 2. ENGINEERING DEPARTMENT: DATE: N/A 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: —DATE:—N/A. 6. PLUMBING INSPECTOR: DATE: N/A 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS:- 0/ L_ rt c.e• i V2 1- fr r-/z-t—T eo N — W" AF N I_J-""A/c %iCNto ✓FD Ic ,� *c I k //Q-iv �p/sTS ri1C TiPC LEA /r u t-97—,P4L,. - 4-n_6 RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: WhMPY—Bn7dmgDepr. - Yellow Copy —Health Dept. - PmkCoPY—EimgDcM - Goldaaod-FueDWMoawvation TOWN OF YARMOUTH Building Department a Town Hall Yarmouth, MA 02WA (508) 398-2231 ext261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: Applicant Name: Location: Owner's Name: T-03-041 Chris Lee/Town of Yarmouth 00096 BRAY FARM RD N (-108) TOWN OFYARMOUTH Owner's Addres 1146 Route 28 South Yarmou MA 02664 Owner's Telephone: (508) 398-2231 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 7/19/02 Issue Date: Expiration Date Comments: removal of 2nd story floor joists, build stairway to 2nd floor This Is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 7/23/02 TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ , (508) 398-2231 ext.261 PERMIT NO �: 606-1455: - PERMIT ISSUE DATE :_ _6/_8/2006_ _ : PROPOSED USE _ ... _ _ ; " APPLICANT ;ChweCar,opy"""'"""'"'""""'""': .............................. JOB WEATHER CARD PERMIT TO Miscltent AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRI R Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: CONST TYPE LOT SIZE erect temporary tent - duration: 6t3M - 06IM6 REMARKS np AREA (SO FT) EST COST ($ $0.00 PERMIT FEM OWNER aylor - Bray Farts /rown of Yam mm BUILDING DEPT BY ADDRESS 11146ROute28 SOuth Yam outh 102664 INSPECTION RECORD USE GROUP R-4 CONTRACTOR LICENSE 0 Chase Canopy 4 Nickys Lane Mattapoisett MA 8006492055 PHONE 1508398=1 FIELD COPY Date I Note Progress - Corrections and Remark I Inspector T c r ti rt REGISTERED APPLICATION NUMBER F7002 rate of 34TIamp +RP,,i,atttnce ISSUED BY ANCHOR INDUSTRIES INC. Date of Manufacture EVANSVILLE, INDIANA 4771 i MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN F2012 4/1/89 _ This Is to certify that the materials described have been flame-retardant treated (or are Inherently noninflammable) and were supplied to: NAME: Chase Canopy Co. CITY Mattapoisett STATE MA Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code, equal to or exceeds NFPA 7019 CPAI 84 Part 3.5.9 of CCC-C-428E `also Method of application: IMPREGNATED clAe sified by UL Flammability only 3541) Type, color and weight of canves/vinyt: 12 oz- Gala Pink/White Description of item certified: 40 x 120 6 C S P q. End Party Tent Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric E�nitevi 11 � .•.ram , j Name of Applicator of Flam7RRestistant nishSigned:Graniteville, STENT DEPARTMENT —ANCHOR INDUSTRIES INC. Louis R. Brown EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 . South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: /08 �3%'r+Y F�te.�l K S�fI �� lOcrj�(Qoe�T ASSESSOR'S NFORMATION: 1. Map- /5/ Parcel: Zq a :;9 C5o0 -G4� O Raidattial ❑ Camnaaal Est Coat ofCauDurtiae f_tr ?OC7 . v r✓ Horne Imprwmment Conuacta tic N tion Supaviw Iic g WorlortaWa Campeonalon hwxm= (do* one) O I am th haneowna O I am dte sole p.oprickm O I how Worker's Compensadon henzsatoe Ittsttrutcz Company Name: Worka's Carta Policy 1 WQRK 1M BE PERFORMED tenet (Fire Res.ndrt Ce+tiScaae enstacleed) 3C Wood Ssove Shed a Sidial: N of Swam O Replact mmat windows d 1) Reproemeat dme I a Ro-root t of s"M () stripping Old *Ago=* Me debris WEE be ds.tto.ed () 6oiRa eve Yyars of a>ostiaa roof it 1 1 t" F I ' adder Pe "ia of Perjaq that the SM=wb bdee eooftim dam ban and correct to the beat of wty taow k dSe and belie[ 1 andsssuad that my Wn answa(s) will be just nose for dcoW or revageoa of dry hems dad far seder KG.L A.261. Setceoa 1. Applicant's Signedee owsmsil,st.rc(orattacbWAN Approved [ty-. Dente Bedding 01> W (or dempee)' Zoning District: I U11� Watorical Datrict:A Yes 0 No Flood Plain Zone: Vd" Ya 0 No Water ResoeaR Protection District: Within 100 & of Wetlands: 0 Yea p No )21 Yes 0 No 3101 a r TOWN OF YARMOUTH Building Department _ ...... _ • (508) 398-2231 ext261 BUILDING PERMIT NO FB-04-1118 - ISSUE DATE : _ 4/1212Q04 PROPOSED USE _ _ . .. PERMIT APPLICANT .....d......... ....:....... JOB WEATHER CARD PERMITTO MiscJtent AT (LOCATION) RAY FARM RD N (-108) ZONING DISTRICTR 40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 115124 BUILDING IS TO BE: CONST TYPE USE GROUP= LOT SIZE CONTRACTOR REMARKS temp tent duration 52M - 5/30/04 LICENSE AREA (SO FT) OWNER OWN OF YARI ADDRESS 1146 Route 28 South Yamwuth EST COST (S 5700.00 PERMIT FEE ($) 50.00 _I BUILDING DEPT BY INSPECTION RECORD POB 48 Mattapoisett MA 02739 8006492055 FIELD COPY Date Note Progress - Corrections and Remarks Inspector V f.- 5/ '1Z e7d `\ o T��S x i a Y %Y.�Se,,, s �rc-We - O Per^ Kc� anted S�P�`�►5 - Lf x�i W&\1 -- Navy Si ruc.•u.4 kr-2Q\o.ce tLe �ernie�� �� 11 �yc�C,\ So\�s rev �e� .+ mac loomed wLl '6A L-. vF sizes - Sow�e 51��v+nnne t SoY�. r<o�ck.ec�, C> \ e xt STv-e1 �t \oo r hc�car� TOWN OF YARM OUTH Building Department BUILDING _ _ _ _ _ , (508) 398-2231 ext.261 PERMIT NO B_ 06-1455. - PERMIT ISSUE DATE 6/8/2006- _ ; PROPOSED USE _ _ _ _ _ _ _ APPucaNr :cr,a ce�,�ir' ' ' JOB WEATHER CARD PERMIT TO Miscltent AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRI R-4 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: CONST TYPE 5•B USE LOT SIZE OW temporary tent - duration: 83(06 - 06105108 REMARKS AREA (SO FT) EST COST ($ L$0.( OWNER eylor - Bray Farm /Town at Yon uith ADDRESS 11146ROute28 South Ywwjth MA 02664 IN PERMIT FEE ($) BUILDING DEPT BY R-4 CONTRACTOR LICENSE 0 Chase Canopy 4 NWs Lane Manapoisett MA 8008492055 PHONE 15083982231 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLCABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION . wFnm F APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REOUIRED FOR FINAL INSPECTION HAS BEEN MADE ELECTRICAL PLUMBING/GAS I WHERE A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL REQUIRED, SUCH BUILDING SHALL NOT BE INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS 1 1 1j 2 2 2 3 OTHEIB: 1 2 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION OF d� TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO 6-66-1455: .......... , PERMIT ISSUE DATE 6/8/2006_ . ; PROPOSED USE • ... ... . APPLICANT :Chase canopy" " " " " " " " " JOB WEATHER CARD .............................. PFRMITTn ' Miscitant AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRI R-4 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: LOT SIZE erect temporary tent - duration: 6 iM - 06105J06 REMARKS CONSTTYPE 5-B I USEGROUP R-4 AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER ITaylor - Bray Farm frown of Yarmouth BUILDING DEPT BY ADDRESS 11146Route28 YOUR SPECIAL ATTENTION is called to the following CONTRACTOR LICENSE O Chase Canopy 4 Nickys Lane Mattapoisett MA 8006492055 PHONE 15083982231 77771 This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this jurisdiction including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the tune permit Is issued must be displayed on premises. The Department must be notified and inspection made of prior construction work as requested on weather card. Al new buildings and additions and alterations to existing buildings require a minimum of three called inspection, namely.1) Footings, drain tile systems, foundation and basement walls, when walls are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanics! systems are Installed. 3) Final Inspection when building or structure Is completed. On Jobs Involving reinforced concrete work, inspection must be made after steel is in place and before concrete Is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been inspected and approved by the Department In accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee is also charged predicated on the extent of the variation from the original plans. Permits are rat valid if construction work Is not started within six months from date permit is Issued. Request for Fhal Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been Installed. Painting or decorating is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY 3flr os3(o EXPRESS ' vows v 77peaftM96 FeeS Gl'amit ex UILDING PERMIT APPLICATION — TOWNOYYARMOUTH---- -- --- — Yarmoath Buflding Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: / UC) / 7 a-0 ASSESSOR'S INFORMATION: Map: OWNER: le wN NAIL PRE CONTRACTOR: CiI�I CG S eic op y Z .. lea-rhr.��Por� /Ylft ozG7� �a rfvt 4, l rADDRFss �lC.(Lri �S � • /YIG. ❑ Residential ❑ Commercial EsL Cost of Construction S Home Improvement Contractor Lie. # Construction Supervisor Lic. 0. Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance goo- 6f 9—Zo55' Msurance Company Name. Worker's Comp. Policy# W // WORK TO BE PERFORMED a'Teat (Fire Retardant CertiBcaoe attached) Duntioa �P o� nv)lOZM - woos smve Shea ❑ Siding # of Sgwm ❑ Replacement window # ❑ Replacement doors: # ❑ Re -ME # of Sq=U () Stripping old shingles• () gong over I"M of existing roof 'The debris will be disposed of at Location of Facility I declare under penalties ofpcUtuy that the statements bete -in contained are true and correct to the best of my knowledge and belief. I understand dw my false answer(s) will be just cause for denial or s5vocatim of my liccnpp and far prosecution under MaL Ch. 268, Section 1. Applicaufs Signaem: c 5as-31,s-p rd, arm plies. �=, - Owners Signature (or 6tt8dune3d) pipe Approved By: Dare: Building Olicial (or designee) Zoning Historical District: ❑ Yes ❑ No Water Resource Protection District ❑ Yes ❑ No 5'— Z 3 —OC,--. Flood Plain Zone: ❑ Yes O No Within 100 8 of Wetlands: ❑ Yes ❑ No 3/01 ��` .. � •w v�.•..••��. w.nw•r..•J �r�wrw..r•w•w.rr0 - Department ojlndustridAccidents= -- .-_ -- -- �; •` - < - --- - O,(jicx ojlnvestigations ---- ---- _ 600 Washington Strut Bostony MA O2111 _--_ www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Ele'ctridans/Plumbers Aoolicant Information— - =----- —_—=-- - --- - Please Print Legibly - Name olosineSso Address: City/Statemp: Phone #: Are you an employer? Check the -appropriate box: - Type of project (� 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees 2 ❑ I am asalle (ill proprietor partner, • listed on the attached sbeeGhave bired the � 7. ❑ Remodeling ' ship and have no employees These sub -contractors have s. ❑ Demolition working for me in any capacity [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and in 9. ❑ Building addition required.] officers have exercised their lo•❑ Electrical repairs or addition 3. ❑ I homeowner doing all work right of exemption per MGL 11.❑ Plumbing repass or additions myself [No workers' comp. c. 152, § 1(41 and we have no 12.❑Roofrepairs issuance required ] t emPbyces. [No workers 13.❑ Other camp• insurance required.] . -nny "puma ma oases cox s e must am nu ON tee secaen below stowing weir woken' eompeaatim loHey inibrm•6m - t Homeowner who ada t d& afdartt iodicaNq mey nn doing an work and they biro obtdde bouftetws mot submit a new affi&vk lofficating sock tCoftwlon the abeek this boat mna attaebed ire additioad sheet showing the irons of the snb•oonb=ftn sod that woaka o' comp. policy Informatiom lan as employrrthat lsprovidGg workers'eompensedon lnfonxistim IA 11 :11 Y Policy it or Self -ins. L .' #:- a+y employeez Below 6 the pellet' and job sit Date: Job Site Address:. CYty/State/Zip: Attach a Copy of the workers' compensation p4cy dedaratloa page (showing the policy number and expirnUon date). Failure to secure coverage as required under Section 25A ofMGL•c.152 can lead to die imposition ofcriminalpenalties of fine cup to $ 1,500.00 and/or one-year iaiprisomnent, as well as civil peaaBies in the form of a STOP WORK ORDER and a Sue of rep to $250.00 a day against the violator. Be advised that a copy of tbit statement may be forwarded to the Office of Iavcstigations of the DIA for insurance coverage verification I de hereby certify under the pains and peeahin ojpedW that she lnjwmadon provided above It teas and correct _ Siomtum Daft: Offlelal use only. Do not write In thb area, to be eoarpketed by eI y or town o2kial Cky or Tows: Permit/License b Issuing AuMorhy (drde one): 1. Board of Health 2. Building Department 3. Chyfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: I Phone il: Information anu_mait, u.:tl%Pua ~Massachusetts General Laws chapter 152 requires all employers to provide workers' compewalion for then employem >s defined as "..:every person in the service of another under any coact of Lire+ Pursuant to this statate, an employee express or implied, oral or written." An enWWer is defined 23 "an individual, partnershipl association, ootP°mti0°,°r other legal entity. or say two or more Igod in a p� enterpriseand the legal representatives of a deceased employer, or the of the foregoin8 ssociation or other legal entity. employing employers- Iiowevc.t the - - - receiver or trustee of an individual, partnership, a - . e having not more than three apartments and who resides therein, or the occupant of the owner of a dwelling hors to do maintenance, construction or repair work such dwelling house dwelling house of another who employs Persons 9iereto shall not because of such employment be deemed to be an employer." or on the grounds or building appurtenant . MGL chapter 152,,25C(6)also stain that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the eommoawea m for any applieant who has not produced icceptable evidence of compli"ce with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public WA until acceptable evidence of compliance with the hmrance its of this chapter have been presented to the contracting authority." Applicant Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if ncassMr, supply sub-contractm(s) name(sl address(es) and Phone munber(s) along with their certificate(s) of insurance. Limier Liability Companies (aQ or Limited Liabiity partnerships (LLP) with no employee: other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employers, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial hould Accident for confirmation of insurance coverage. Also be sure to sign and date the afridavl d The t be returned to the city or town that the application for the permit l iryou �•a e being of Industrial Accidents. Should you have any questions regarding comimosation policy, Please call the Department at the number listed below. Self -insured oompames should enter therr self-insurance license mmift on me line. City or Tom Of idols Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event die Office of Investigations has to contact you regarding the apPlicant. Please be sere to fM in the pmnid icense number which will be used as a reference number. In addition, an applicant that most submit multiple PetmiNiceose applications in any given year, need only submit one affidavit indicating Gwent policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in ' (City or mwn}" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as pruof that a valid affidavit is on file for future permits or licemes. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license of permit not related to any business or commercial venture (ie. a dog license or permit to bum leaves eta.) said person is NOT required to complete this affidavit The OfSx ofImrostigations would lace to thank you in advance for year cooperation Rod should you have any gaeationa, please do not hesitate to give us a call The Department's address, telepbone and fax member: The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street. Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-V7-MASSAFE Fan # 617-727-7749 Revised 5-2645 www.mass.gov/dia 05/24/2006 16:26 "C"'rvrreasne nananow¢ At Nefry IMSIranee Age nCY FaxJD: To: ASeon NO.679 D02 Onto: 624106 01:41 PM Pape: 1 of; I ACORD, CERTIFICATE OF LIABILITY INSURANCE oSE PID 3 DATEOS/29/0IMM4/0TJ CHA6 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sezzy Insurance Agency 300 Congress St suite 306 Quincy MX 02169 Phone:617-479-SS00 FaX:617-479-0761 Chase Canopy Company, LLC Daniel Chase 4 Nicky'S Lane P_0. Box 46 Hattapoisett Ma 02739 r•nvee e.�rc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW. INSURERS AFFORDING COVERAGE _ _ NAJC4 rcv,1.`RA It Ira" rive a narin, in_]. ca. — :r'rAir,6 Oneseacon Inns. Grp INSLKr(C` • AIa Insurance COlipany IZY [AC :ILr,rIr.p.•g �f�r.-IY.E LILTED OCLO:�la?':h bE tk '-L-: T'? MSLR£C'11N.CP.�:YC F,F 1rrL :LI,'i I2fi1C9IK.NGITEU. tF;'n:Ti�:'•fOE1: R'rJ.TLITII:i, Lf rvA+:iF/IP+r'i1. r+TIfi+r MD.b1EM'NRHPIM rTT{r,t9.:n'-JSCGATIFICATFI,ur�h'r/Ft•:r: ,%,. PV:T-.k T#lf:lr!.• tt�. P nT.] l T, +r: r+ li.r: P L AFG� al tl' l:'+ AFL FtiY: SS CC4CPIFF[1 IfF'F.IrI IS :'+Jtdct I R' ALL T•,E-LR';... CrA-LLr,IC+G Nt• ri N.�Ta JF, :F ;'.I: - P:aiCIES /.i+eaAE': :lE Ll1,.^. •, SK"?'r, 1.141Pv ►AID 4LAlhl-.. LTR RSRd TYPE Of NSURArlCE • _ POLICY NUMBER OLTtY 1•.FFE ^ DATE(MMMD/WI TEIMWO` MLSnn"a I.GF;BRLL LIABILITY I ELH!':CU'RE:Y.E S 1,000-,000 A !X'':CN>.tEL.:tcLI;EIZ;AL::EC r.1 CX00218484 07/06/05 117106,06 rfel;f;-t:�aa' '*— ,000,000 :LAIr.l- it -cc � : :: Imo, I LL•C C•% l,a w Shl �i 120,000 N.000,000 ,.?y WC; I�I • !II +•:e'E=.+c-+;+:FiSv'7r Ji2,000,000_ • �rJL v•:FGr.+S LIFS'r.=G awk"�• • _ _—• _-- - G;:(II:T'• +.f.W,r]i�t 02,000,000 r AUTOMOBILE LIABILITY 8 Jr PJ'J'-]!IO CBXZ517D1 OS/21/06 05/21/07 tC`Ir]{�Lu� s1,000,000 • IX r' IX NCrrie;ftL a•rn. I . CGIL•.• JLi.FT .,F+r a.iJedi = OARAG9 LIABILITY �.•LRi.ilty [.:.:•:IL E!JI .i EXCESSA"RELLAuAeILrT•r =•:n �,..-.,t;: Eti:.E F r11GC' rAtC .. i I ,f IWORKGRS COrVCrmA71Or, ANIS : h B-IMCI ER4' WBR." C Nr.c1CFFI£P:a.Pnftr(PS-I Lmt RC776209S 09/16/05 � 09/16/06 ':4Fitr+llT -...-.._. e_E4:H.;a:rcr,r t100L000 rp►?;ECAiFbbE.4Eu;l'JCiC^ — _..... rl �.�. Of. cte LrJrr FL L+;kA;;E•E].I-FL•}•)-- 1100 000 I :CIF; I>L �G .F.'I;,l,Hi•tib.. AFL-1 N'.Ea_tB-P:'IT i500,DOD O71ER OESCRIPTn.MI 4:4 OVEkATiOUL: LOLAT NS 1 VEMICL S I 6%:LUEIONS ADDED BY ENCO . NT I SPECIAL PROVISIONS Operations Usual to tent and canopy rental/Event dates: 6/2/06 - 6/5/06 CCQT1cIr•eTe unI nan _ _ _. _ _ ' TAYLOPP sHouLD. N7 OF THE ABOVE DESCR2E0 ►OLICIE7 6E CArKELLED BEFORE THE EX►IRATION DATE THEREOF, THE ISSUR:o INSURER WLL ENDEAVOR TO MAIL 10 OX.-J WRITTEN HOME To THE CERTIFICATE NOLOER NAMED TO THE LEFT. SLIM fAILURE TO DO SO SHALL' Taylor hearPreing Benefit itSOC• IMPOSE NO OBLIGATION OR UADIM OFANY KIND UPON THE PJSURER. ITS AGEIn OR Sheep sheering Benefit 108 Bray Farm REPRESENTATIVES. Yarmouthport xx 02615 AUTTy�1lED•REPRESENT4J1TiVE��_ - / �. _ Ud3 -L3 PC nLPtn�rs�IR,R1 LnUj III IMPORTANT D V (: U M t N 1 r'1Ur�ruuurur�r�cuuuuu� REGISTERED APPLICATION NUMBER F140.01 (Certtfirate bf.fflamr �i.Eoiotar�rE Txe1ISSUED BY �® INDUSTRIES INC. vtom EVANSVILLE, INDIANA 47711 MANUFACTURERS OF THE FINISHED '�----1' TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have (or are inherently noninflammable) and were supplied to: CHASE CANOPY COMPANY 4 NICKY'S .LANE P O BOX 46 MATTAPOISETTE MA 027390406 Certification is hereby made that: The articles described on this Certificate have been treated chemical *and that the application of said chemical was done in Marshal Code, equal to exceeds NFPA 701, CPA[ 84, ULC 109. The method of the FR chemical application is: •f Date of Ma U." ro Order N 21_ been flame-retardan, 1 TL Lpx,20� bt (, Y 6.0 with a flame-retardant conformance with Vaiil Serial #: 8140300 (0001) Description of item certified: CENT END 40W X 20 LO VL W W Flame Retardant Process Used Will Not Washing And Is Effective For The Lif Signed: Name of Applicator of Flame Resistant Finish e Be Removed By 6 Of The Fabric .0 9L� TENT DEPARTMENT —ANCHOR INDUSTRIES; IN m r REGISTERED APPUCATION NUMBER F140.01 IMPORTANT DOCUMENT A xlert ttuta�tr I V r G) , 11 tr "L"taj tLr ISSUED BY 101! usraO EVANSVIULE, INDIANA 47711 MANUFACTURERS OF THE FINISHED �—� TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have (or are inherently noninflammable) and were supplied to: . CHASE CANOPY COMPANY 4 NICKY'S LANE P O BOX 46 MATTAPOISETTE MA M7390406 Certification is hereby made that: The articles described on this Certificate have been treated chemical and that.the application of said chemical was done in Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. The method of the FR chemical application is: Serial #: 8140200 Description of item certified: CEN.r END 40W X 20 HO VL W W Flame Retardant Process Used Will Not Washing And Is Effective For The Life Signed: Name of Applicator of Flame Reststant Flnish Date of M nu sure 2Po5108fu Order Number 181585 been flame-retardant treated 7c yOX =--2aZ with a flame-retardant approved conforinance with California Fire (0001) Be Removed By Of The Fabric TENT DEPARTMENT —ANCHOR INDUSTRIES INC. .... ..... .... r. so REGISTERED APPLICATION NUMBER F1401 M P O R T A N T D O C U M E N T ���������P��&RP���� jjRPrj - A irate of flame ISSUED BY (Ms OWN ES INC. EVANSVILLE, INDIANA 47711 TMW MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have (or are inherently noninflammable) and were supplied to: CHASE CANOPY COMPANY 4 NICKY'S LANE P O BOX 46 MATTAPOISETTE MA 027390406 Certification is hereby made that: The articles described on this Certificate have been treated chemical and that the application of said chemical was done in Marshal Code, equal to exceeds NFPA 7019 CPAI 840 ULC 109. The method of the FR chemical application is: Serial 0: B140300(1) Description of item certified: CENT [ND 40w x 20 L O VL w w Date of Manufacture m 05/26100 a Order Number 319211 been flame-retardant treated _rc y�X'7 v'gc- - with a flame-retardant approved conformance with California Fire _ Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDERMFO NEW PHII.ADF.L.PHIA.OH Name ofAppllcalor of Flame Resistant Finish Signed: ILIS' - TENT DEPARTMENT —ANCHOR INDUSTRIES INC. 113 ........... ........... __..... .._.____..T_. o� TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ - _ _ _ _ , (508) 398-2231 ext.261 �'- PERMIT NO �_ 6-06-1457- "'--'- PERMIT x ISSUE DATE :. _618/2006. _ : PROPOSED USE APPucANT samstawecaa,iysn rsoepartrrient : ............................ JOB WEATHER CARD PFRMITTn - MiseJtent AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRICT R-40 Bldg. Type: Res(dential SUBDIVISION MAP LOT BLOCK 115124.1 1 BUILDING IS TO BE: CONST TYPE" USE GROUP" LOT SIZE temp. tent - duration: GW6 - 06/0, d REMARKS AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER I Taylor - Bray FamtirTown d Yarmouth BUILDING DEPr BY ADDRESS 11146RoLde28 South Yamauth MA 102W4 CONTRACTOR LICENSE O PHONE 15OM82231 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remark Inspector of r TOWN OF YARMOUTH Building Department BUILDING - - _ _ _ . (508) 398-2231 ext.261 = PERMIT NO 6-06-1.... PERMIT •. ISSUE DATE ,61812006_ , ; PROPOSED USE _ .... _ _ _ , APPLICANT :BamstadeCounty SherrfYsDepertmeM JOB WEATHER CARD PERMIT TO Miscltent AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRI R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK BUILDINGISTOBE: CONSTTYPEF-1 USEGROUP LOT SIZE temp. tent - duration: 613106 - O&D&D6 REMARKS UP AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) 1$0.00 OWNER I Taylor - Bray Famdf own of Yamraith BUILDING DEPT BY ADDRESS jll46RoUt028 South Yamtouth MA JWWA CONTRACTOR LICENSE PHONE ISOM982231 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEW ERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE REQUIREDFOR PPE CONSTRUCTION WORK: 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL FINAL BEEN ICAL FOOTINGS. 2 PRIOR TO COVERING STRUCTURAL WHEREAPECTIONHAEOFOCCS PA WHERE A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL INSTALLATIONS. MEMBERS (READY FOR LATH OR FINISH REQUIRED, SUCH BUILDING SHALL NOT BE COVERING) 3) FINAL INSPECTION BEFORE OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4) REFER TO DETAILED INSPECTION BEEN MADE nri-iFntti F POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS 2 2 \ / � 1 2 OTHE(2: / 3 1 2 3 4 b WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS WORK IS NOT STARTED WTTWN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS PERMIT IS ISSUED AS NOTED ABOVE. OR W RITTEN NOTIFICATION. STAGES OF CONSTRUCTION • ' , TOWN OF YARMOUTH Building Department BUILDING _ . _ . , (508) 398-2231 ext.261 = PERMIT NO B-06-1457 PERMIT ISSUE DATE : _ .61W2006- PROPOSED USE _ _ _ _ _ _ _ APPLICANT :Barstat'eC-o" ,ty"sn&rtirsoeparar;eM' " JOB WEATHER CARD .............................. PERMITTO------------ MiscJtermt AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRICTR 40 Bldg. Type: Resklential SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: CONST TYPE= USE GROUP O LOT SIZE temp. tent - duration: 6J3/06 - 06/05106 REMARKS AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER I Taylor - Bray Farn/rown of Yarmouth BUILDING DEPT BY ADDRESS 11MRoute28 South Yarmouth I MA 102664 YOUR SPECIAL ATTENTION is called to the following CONTRACTOR LICENSE 0 PHONE I5=9=11 This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this jurisdiction Including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit is Issued must be displayed on premises. The Department must be ratified and Inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimurn of three called inspection, namely,1) Footings, drain tile systems, foundation and basement walls, when wails are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish carering but after f irestopping, electrical, plumbing and mechanical systems are installed. 3) Final inspection when building or structure is completed. On jobs involving reinforced concrete work, Inspection must be made after steel is In place and before concrete Is poured. The Department reserves the right to reject any work which has been ooncealed or completed without first having been inspected and approved by the Department in accordance with the requirements of the various codes. Any deviatior from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee Is also charged predicated on the extent of the variation from the original plans. Permits are riot valid if construction work Is not started within six months from date permit is issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work Is completed and heating apparatus ties been Installed. Painting or decorating Is rot required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY .e I�9T0TT In MAY 2 nn ,,006 D II �9 EXPRESS BUILDING PERMIT APPLICATION 'DOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yetmouth, MA 02664 (509) 398-2231 Ext. 261 r. !08 �3rr� � ntr 2�• �t7a•_ l�an�.ou�G P.-'f FYS-g -1<e;:81jIUX— 7�fy1G :A : /S/ 1 Pmck AY- i 7rJ.. a ❑ Raidadw ❑ cmnmerew FsL coal of cam uctien $ Home tmprommcrd ca tactor Uc. s c mtrlxdm sapervrisor Lao. d workmen's Campenadon bmsanor (che* me) ❑ Ism the homeowner ❑ Ism the sole propriety ❑ I have WccWs Campemedoo Ituaataxe hssmaece Uompegy Nerve: Worker's camp. Polio" -11�WORK TO BE PERFORiVfLD raw (MRewr&dCetlllabaCacUo Up err .Tvit3 Dsratba .Z cQ2c%S dD-zj l on tTvn S WoodStova Shed ❑ Siding: s ofs9w" / 0 Replaeemeet wWowe A o Rephoeaemt doeac ORa.aoot $ofSgimw () ft#Pf[ old *Was* () going ova larn ofcdedos root wM debris will be dspord ofat l.00atloeoftki ty eatbs¢Rt r` �. �' + Ca1 1 Iare cadet pasltias of parJny fiat the ddemseb beeeI coofthod era true and cars! to tier bad ofzW knowledge and bdiet 1 tmdeeased lint soy ebs assww(s) will bo Jos own Jbr denial or mocstion ofmy Bpease and Is tioe w dw KO,L. C4268. Section i. .T"'��"` OwamSlyrtwo(aaWohmmt) Appew W By Date Bsiilding Ot cW (a dedgm) Mdorical District ❑ Yes ❑ No Flood Ph in Zones ❑ Yes ❑ No Water Res«aae Protecdm District ardda 100 tL of Wedlan&: ❑ Yes ❑ No ❑ Yes 0 No 3101 i n .. I .—NIAY. 24. 20D6-10:16P NO. 641-A. P. MAY, 411006 IaMM ICCF AD. M) r. 3 ('IMPORTANT DOCUMENT ortuicatle of Flante izesistapm EGISTRATION 166419D 6Y Date ct Ehiph]snt 4PPUCATION OEM t4VANSVILL.E, INDIANA 47nS Tord {dahlltbatinn FI214 MANUFACTURERS OF THE FINISHED dl9D7dOt TaUrPRODU078 MGCRl= HEREIN This is to certify that the Materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 7990D BARNSTABLE COUNTY CORRECTIONAL 6000 SHERIFrs PLACE BOURNE MA 02532 Certification is hereby made that: The artioles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with Cailiornia Fire Marsha! Code, All fabric has been tested and passes NFPA 701.99t CPAI 84, ULC 109, Serial # 1CM106lA Veaeription of Item cerulied: TMITA7Wl w:wamar:vm Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The.Llfo Of The Fabric IMMESM b'd OEZ9-sLE-9OFi-t-6 j%dcis 4LettS eo *O Rel.t OF tr TOWN OF YARMOUTH Building Department BUILDING . (508) 398-2231 ext.261 PERMIT NO B-05-1338_ PERMIT wM 33�tq, ISSUE DATE : _ 5/18=05 _ ; PROPOSED USE APPLICANT ;chase canopy ' ' ' ' ' ' ' JOB WEATHER CARD . ........................... PERMITTO Misc./tents' AT (LOCATION) 100108BRAY FARM RD N (+96) ZONINGDISTRICTR 40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1060.121 BUILDING IS TO BE: CONSTTYPE 5-B USE GROUP R-4 LOT SIZE CONTRACTOR erect three temp. tents - duration REMARKS AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER ITown of Yarmouth . BUILDING DEPT BY ADDRESS 1146 Route 28 South Yarmouth I MA 102664 LICENSE 0 POB 46 Mattapoisett MA 02739 5087582055 INSPECTION RECORD FIELD COPY Date . Note Proaress - Corrections and Remarks Insoector SHEDS LESS THAN 150 SQ. FT. SHALL BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. BUILDING PERNIIT APPLICATION p [ Q d [ TOWN OF YARMOUM D Yarmouth Balding Department MAY 1 8 2005 1146 Route 28 By M South 39 F.xc 261 coNsrR11CC1IONADDRBss: 168 ASSESSOR'S DWORMATION. msP: nPaiod owmx.10 L-cm 0 G1arkfov-t-4 Nalco tie 433 coumcroR C,1C6e RD, 00K-44, M&P6 /St;OZ73 el Soy. 75y-2095 NMAS MAMM ADDRESS 77LO D RM-dewa1 ° commercial FA Cad of Cm*ucdm S Hemeb*wv mcatContnctcrlic / CamtructimmS%Xrvisocum Waikman s Campmatim htsaamec (check out) 0 I am &e homeoarmer 0 I am the sole Proprietor 111 hare Wa ones Campe=6w h won bstame Cow' N' wolbes Camp. Polity/ i 3 wo>Euc m > Pto1a>n IQTad (rim Rdw*aCatiNcdc0whoo DQ.noa- C/S / Wood gem. SWd DSAW Sarsya.ea D Ropiaoemed &aa: / ° wbdowc A 0 R&wa! / of sgoarea nU ddrh wM be diVwW afat Loodiaa of Facaiy I dedae mderpe"m afpegary the de dd=wb herb oouWi are has and oared to the hat army bwwladse and hetie[ I mdadaod>bet any liba aoewa(e) wiD be )ad caoaa for denial a reroatioa ormy 'cameo and far p mewim coder ILG.L Ch. 26; Section 1. AppSc•dtiS' Xap, TaFP Ddc S— / p— D 5 owns. Biprme, (or ethehmeat) Ddw . . Apprmed By ' Ddc � OfBdd (ordeapn.) Zamimg DWrict t1d _ ...- . _ iLsOotiol District 0 Yes 0 No • Flood PWh Zone - 0 Yen ❑ No Water Rdomree Protection District Within 100 R of Wdkndm 0 Yes 0 No ❑ Yes ❑ No 101 -y44 Q-c:nu��ePl butb= l s we of # this Is a =ner lot, rite in name street. : V SHEDS LESS THAN 150 SO. FT. SHALL r BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A PLOT PLAN MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. .FOR LOT # Lndirate location cf garage or accessory building AdditIcas with dashed lines---------���_-- S ex �p�t ( cesspool) I (1dt..........11 ......ft. near) SIDE YARD REAR YARD SET BACK (NAME OF STREET) Inf= atim SIDE YARD Tji REGISTERED APPLICATION NUMBER F140.01 IMPORTANT DOCUMENT' Mnn,-r�n � n�nrF Qf . jrUMP ISSUED BY tNDUST E3110 EVANSVILLE, INDIANA 47711 Rrgigtantr MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described -have (or are inherently noninflammable) and were supplied to: . CHASE CANOPY -COMPANY 4 NICKY'S LANE P O BOX 46 MATr'APOISEM MA 027390406 Certification is hereby made that: The articles described on this Certificate have been treated chemical and that.the application of said chemical was- done in Marshal Code, equal to exceeds NFPA 701, CPA184, ULC 109. The method of the FR chemical application is: Serial #: atqucuu CENT END 40w x 2013o V' L w w t-lame Retardant Process Used Will Washing And Is Effective For The Signed: Date of man rgg ure r w En ►—- Order Nwnber 181585 been flame-retardant treater r with a flame-retardant •a ro a' conformance with California Fire (0001) Not Be Removed By Life Of The Fabric TENT DEPARTMENfT—ANCHOR INDUSTRIE8INC. fill IMPORTANT DOCUMENT ?WAR] rurJ-c nt:Pr it�rJr�� • m A to Cerfifirate bf jr1ame At5k9tantle REGISTERED ISSUED BY APPLICATION NUMBER 2#tND0=US IFSmc. F140EVANSVILLE, INDIANA 47711 .01 E MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been (or are inherently noninflammable) and were supplied to: CHASE CANOPY COMPANY 4 NICKY'S LANE P O BOX 46 MATTAPOISETTE MA 027390406 Certification is hereby .made that: The articles described on this Certificate have been treated chemical and that the application of said chemical was done in Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109, The method of the FR chemical application is: Dale of 11 w Ober 2: flame-retardar TL jlaj�_ 41 �l " with *a flame-retardant conformance with `Call ISerial4: 8140300 (0001) uescnpnon of Hem cermrea: CENT END 40W X 20 LO VL W W Flame Retardant Process Used Will Not Washing And Is Effective For The Life Wag NEW PEMADELM?Z on Name of Appllcato►of Flame ReSIStant Flnish Signed: Be Removed By is Of The Fabric TENT VEPARTMENT—ANCHOR INDUSTRIES iN ..1. IMPORTANT DOCUMENT maloogM@PLP �rJMF rurn�,-�rr��A Cerfifiratr REGISTERED APPLICATION NUMBER F140.1 to of flame Ar-91.0tance ISSUED BY nanusrni� e EVANSVILLE. INDIANA 47711 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This • is to certify that the materials described* have (or are inherently noininflammable) and were supplied to: CHASE CAN6PY COMPANY 4 NICK rS LANE P O BOX 46 MATTAPOISETTE MA 0273SD406 Certification is hereby made that: The articles described: on this Certificate have been treated chemical and that the application of said chemical was done In Marshal Code, equal to exceeds NFPA 7019 CPAI 841. ULC 109, The method of the FR chemical application Is: . Serial #: 8140300 (1) uescnption of item cerlitied: CENT END 40W x 20 LO vL W W w Date of Manufacture r 05/26/00 Order Number 318211 been flame-retardant treated • j � y�X� vim' -� y • NrN 0 with a flame-retardant a m PProved conformance with California Fire Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDHR MPG NBW PHILADELPHIA,OH Name of Applicator of Flame Resistant Finish Signed: -.1? gru 1Z . TENT DEPARTMENT —ANCHOR INDUSTRIES INC. 11, 04/19/05 13:51 CHASE CANOPY COMPANY-) 15OW98083G NO.372 D01 P.O. BOX 48 MATfAPOISETf, MA 02739 TELEPHONE: 508-758-2055 FAX: 508-758-2083 E-MAIL: Info@chasecanopy.com WEBSITE: wwwchasacanopy.com Taylor Preservation Assoc C/O Lynn MacIntyre P.O. Box 66 Yarmouthport, MA 02675 ATTY. LYNN MACINTYRE Phone: 508-385-9407 Salesperson: Andrew Chase Event Time Start 06/05/05 End 06/05/05 Page: 1 Date: 04/19/05 Revised Contract: 985208 3 Work order-.804399 Acct ID: TPA Type: CHARITY Site: 108 BRAY FARM/NORTH YARMOUTHP.ORT Setup Time Removal 06/03/05 06/05/05 06/03/05 06/06/05 Thank you for your order. The equipment listed below has been reserved for your event. Time *IMPORTANT. FINAL changes to your order must be received before 05129/2005. We cannot guarantee additions or changes after that. Any changes made after 05/29/2005 will incur a $25 fee per occurrence. 4-- COLOR DESCRIPTION RETAIL STANDARD EXTENDED -------- --- --- 1 PK/WH 40X60 ANCHOR OLD R&P TENT 1,354.00 700.00 $700.00 General Contract Notes PINK & WHITE TENT Thank you for your order Payment Terms: 3 DAYS PRIOR TO DELIVERY Subtotal TOTAL Rec'd To Date BALANCE 700.00. $700.00 -700.00 $0.00 135400 10.1C(579) l TOWN OF YARMOUTH - pR@ OTC JUN 0 3 2005 D i N APPLICATION FOR PERMIT TO DO PLUMBING j (OFFICE USE ONLY) By Fee: $ A) 4cr PERMIT NO. P- 05 — 755 F Building Owner's Tom of YA��n�TA AT: Location /06 (�417rr j2 j��>��fiVame New ❑ Plans Submitted Renovation lLY Type of Occupancy-5Lvy. L, Replacement ❑ �Q \J� o �N- x Cn J en p O y Z Z� `\ \1 0 Z(n F Cn W Q 0 x~ a Z O Z C7 Z N Z n 7 W N U. W O O W Q W M Q W y C J Z D O. Q -J W V Q x 3= a Z x 3 Y O. O ~ Z Q W LL Y W a Q Q x N Ln Q a O Q 0 0 Q¢ _2 M x a O Q H 3 Y J m 0 o c � 3 x F rn u- c a 3 cc m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name ,� (� ( Ge�Tt_ _ ❑ Corp. Address 7�2e \t i fi / ❑ Partnership �,4i41-A{o irnVCompany Business Telephone Name of Licensed Plumber DAiz O nu V F rizsx INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by the ' g the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of OwnerorOwner's Agent 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ `-" v SigrMure of Licensed Plumber License Number Type: Master❑ JoumeymanZ:]-� I) a r •. TOWN OF YARMOUTH Building Department (508) 398-2231 ext261 PERMIT NO F6-04-1118 ISSUE DATE :- 4/12/2004 :: PROPOSED USE BUILDING -; PERMIT APPLICANT :chase ca�,opy ' ' ' ' ........ ' " ' ' : " " ' ' ' " : JOB WEATHER CARD PERMIT TO Misc Rent AT (LOCATION) ZONING DISTRICTR 40 Bldg. Type: Residential 10DO96BRAY FARM RD N (-108) SUBDIVISION MAP LOT BLOCK 1151.24 BUILDING IS TO BE: CONSTTYPEO USE GROUP LOT SIZE temp tent duration W28104 - 5J3=4 REMARKS AREA (SO FT) EST COST ($ $700.00 PERMIT FEE OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 1146 Route 28 South Yarmouth I MA 102W4 INSPECTION RECORD Date Note Qrogress - Corrections and Remarks 77 CONTRACTOR LICENSE 0 POB 46 Mattapoisett MA 02739 8006492055 In FIELD COPY TP�FPA o� •rq,R� `f z t\jb� EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Bul'lding Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRucnoN ADDRESS: JOB Rem,- Fuitf k9"�f oeAt ODOeT ASSESSOR'S INFORMATION: map: / 5 / Parcel: Zq IaL4aYNaI a 02-731 800 -G¢t 0 Residential ❑ Commercial Est. Coat ofCantrttedon $ ff ?oc7. o G Home Improventew Contractor Ix 8 C nstruaion Supervisor I9a it Workman's Compenswon baumn= (check one) ❑ I am the hanoowner 0 Ian the sok proprietor O I have Worker's Umpensation insurance Insurance Company Nat= Worker's Comp. Policylf WORK TO BE PERFORMED Tan (FireRetarduatCertifioteatrached) Dutadon Mafia uj0 Wood Swve Shed 0 Siding: a of Squares O Replsceracut windows: a 0 Rep6eemeetdoom 0 0 RD-toot ! of Squares () Stripping old sbingW* *The debris will be disposed of at () going ovcl by s ofcosting roof APP (� YARvolml C01 lllgy Y I declare rode penalties of perjlay that the statements kerein rnrrtaiaedarc bw and eon to the best of my knowledge and bdiet: 1 understand dot say fabe anm r(s) will be just cause for denial or revocation of my Haase and for Wade Rol. (I.268, Section 1. Applicant's Siyutar e ostC Asa. 5 sue^ OwnersSigeatm(aattaekment) �FSS— 4 Date: Approved By: I Date: . Building Official (e designee) Zoning District: 12 l V /IF= Historical District:AYes D No Flood Plain Zone: O No Water Resouroc Protection District: Within 100 L of Wetlands: 0 Yes QI No )� Yes O No 3101 Tato'firate of 3itnwc � aesotootunre REGISTERED APPLICATION NUMBER F7002 ISSUED BY ANCHOR INDUSTRIES INC. Date of Manufacture EVANSVILLE, INDIANA 47711 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN T2012 4/1/89 This Is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: NAME: Chase Canopy Co. CITY Mattapoisett STATE MA Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code, equal to or exceeds NFPA 701, CPAI 84 Part 3.5.9 of CCC-C-428E (also Method of application: _IMPREGNATED classified by UL Flammability only 3541) Type, color and weight of canvas/vinyl: 12 oz. Gala Pink/White Description of Item certified: 40 x 120 6pc. Sq. End Party Tent Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Granitey:lle �omnany Name of Applicator of Flame Resistant Flnlsh Signed: 6'L' f. Graniteyille, SC _ TENT DEPARTMENT —ANCHOR INDUSTRIES INC. t4r�trarMrrr' Louis R. Brown BUILDING PERMIT Town of Yarmouth 1 FIELD'COPY 1 1 i tv DATE May 3 2001 PERMIT NO. ' B-01-770 � 1 APPLICANT NorthCA$teTn remm prrinl SQNiCPq ADDRESS P.O.BOX 1392 Pittsfield, HA CS049351 IND.) (STREET) (CONTR'S LICENSE) NUMBER OF _ PERMIT. TOrepsI=B (—) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) lO8-Brest s liOnd Y p n7fi7S O STRICT �i (NO.) (STREET) a BETWEEN AND 0 (CROSS STREET) (CROSS STREET) LOT m SUBDIVISION -I Rl 124 LOT BLOCK SIZE U m BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION I O TO TYPE "3.B USE GROUP It 4 BASEMENT WALLS OR FOUNDATION (TYPE) O ; REMARKS: 6t—.AK �fT per, and vent to coil, AREA OR Q PERMIT _ VOLUME ESTIMATED COST y 16,300,EE (CUBICISOUARE FEETI OWNER Town of Yarmouth ' ADDRESS 108 Brfiy 'Farm BUILDING Rd. Y.P. O2675 BYI INSPECTION RECORD DATE NOTE PROGRESS CORRECTIONS AND REMARKS INSPECTOR Permit # 1R'W 1 U Fee S Nl Permit expires 6 months from EXPRESS BUILDING PERAHT APPLI TOWN OF YARMOUTH D Yarmouth Building Department 1146 Route 28 i,1AY 0 2001 South Yarmouth, MA 02664 `� (508) 398-2231 Ext. 261 BY CONSTRUCTION ADDRESS: (— A 2 M i o ASSESSOR'S INFORMATION: Map: Parcel: OWNER: T ca7wL N PRESENT ADDRESS TEL. # CONTRACTOR: e1n A.�� Q- A,.nrr _O S :c•S�o #3nz l5g7— ?Y:Q�tr u_A _ e,i ez NAME // MAILING ADDRESS TELJ ❑ Residential Commercial ESL Cost of Construction S T Op Home Improvement Contractor Lic. # Construction Supervisor Lic #�/T' Q Q 5( 9 36,: Workman's Compensation Ins (check one) ❑ 1 am the homeowner e I am the sole proprietor ❑ 1 have Worker's Compensation Insurance Insurance Company Name: W EST60nI Squ ?Y t"?! s?aJ'� Worker's Comp. Policy# WORK TO BE PERFORMED ❑ Tent (Fire Retardant Certificate attached) Duration ❑ Siding: # of Squares ❑ Re acemcm windows # ❑ Replacement doors # roof # of Squares �i R ing old shingles' () going over layers of existing roof 'The debris will be disposed ofat: I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belie£ 1 understand that any false answcr(s) will be just cause for denial or revocation of my license and for prosecution under MG.L. Ch. 268, Section 1. Applicant's Signature: Owners Signature (or a Date: • r,-3 — t� .4 Approved By: Date: Building Official (or designee) Zoning Historical District: A Yes ❑ No Water Resource Protection District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Within 100 & of Wetlands: ❑ Yes ❑ No 3Nl A.�j 3" ZOO/ 0'WY.V7- 46;�PIV 67 R=l</A,�.cD Dr.ile o�Zoz y�� -yes z5�i9 �Ow,�( D� yAQM,ovTN yAQrto.JtL OLCo[e� . APPROVED YARMO O HRD COMMITTEE D A� s��, f� T Am.. w4mr:' %i" 6 —^ o ��quFs- App,ACO A-L ..Peov, �o lc-t K„ s [-� �� �Cwa J ; 40 O�aI'A4 ct 6v-I G t� � , pe.ew`CT -moo 7oo4- F/nl Eci! GL� •lO�s t3ra S.? r4Rlw� O-� 'E'er Fx L";T/ru eFbAti,Z, 2cz� SDI4 r Allest rR-P(Xt r P I ! .. 1 1 1 � i-Ati.4-DOM 04 L; jc� K-JAI> e,ejaLe, s11l l [ram I gr ,J e -4- Pic ►�� vn.M. stL�e G / A-C P-f2 O c� , /�drnPT€�y (ginisK�t�`cU YR� BUILDING ; c TOWN O F YA R M O U T •H ELECTRICAL 1146 ROUTE 28 SOLTH YAM101.1TH GAS NASSACHUSETI.S 0_664 'Telephone (508) 398-2231 PLUMBING o - BUILDING DEPARTMENT I •IV • 1 31M G, ` APPLICATION'To ERECT Arm MAINTAIN SIGN r-->J DATE TO THE SIGN INSPECTOR: UNDER SECTION 303 OF THE YARMOUTH BY-LAWS, THE UNDERSIGNED HEREBY APPLIES FOR A SIGN PERMIT ACCORDING TO THE FOLLOWING INFORMATION: BUSINESS NAME G,fL(;�'f TEL:.3ssS"- 6 Ll 9 LOCATION/ADDRESS In t2 F yv\ (Z ZONING DISTRICT. L.B. G.B. IND. ... RES. MIST. DIST. � BUSINESS OWNERS NAME/ADDRESS Tow iv o r- Yf%2w\oll7t f TEL: OWNER OF RECORD OF BUILDING_ TO tk16t1 Di=yARwlavT(+ ADDRESS SIGN BUILDER ` k%f5w1oPrS -QFt� l ADDRESS (C9 g' ):M" Fi-2yv� 9Q . TYPE OF CONSTRUCTION MATERIAL(S) IM DO LIGHTING TYPE FREE STANDING %< ATTACHED TEMPORARY PERMANENT � . DIAGRAM OF LOT AND SIGN WITH DI.. SIONS AND SET -BACKS FROM PROPERTY LINE. SHOWN LETTERING.AND ADVERTISING ON SIGN. FOR ATTACHED SIGNS SHOW LOCATION ON FACE OF BUILDING AND RUNNING FOOTAGE OF PORTION OF FROWGE.000UPIED BY BUSINESS. • _ It n .WELCOME TO L* - - •••r• lilllllll � �L11J.11.Y\11/� 11111111i8U11 �" L.' wn.ue<• .. %MM NOW— c i 1• WH ' to v" . - 'IiM;IO {UNW t< WiJA4L M rM<,M. tr«wva. - I HEREBY AGREE TO CONFORM TO THE ZONING BY-LAWS, SECTION 303 OF THE TOWN OF YARMOUTH' REGARDING THE ABOVE SIGN CONSTRUCTION. I FARTHER AGREE THAT THIS SIGN WILL NOT BE ALTERED, ADDED TO, OR CHANGED IN ANY WAY UNTIL A NEW PERMIT HAS BEEN GRANTED. THE NUMBER OF THIS PERMIT WILL BE AFFIXED TO THE SIGN IN NO LESS THAN 3/411 ERS. ALL PERMITS SUBJECT TO APPROVAL OF THE SIGN.INSPE R. / APPROVAL By ( ^� _ DATE Vi�� �' IO. /9%� FEED NUMBER 1 APPROVED YAytfpU1H COMMITTEE A 4OKHRO %9� - o rtT • .emu \"11L1��1.��I1VU� ll �i.y -r u ��_��j/J\ j�[�j�►�T\'1�Y1Q ' 1I�IIi'�j(�'���►�� ►�� J �� ��j1�J\ T1I'IPy7�' 1F(1i111 TII f�11J1\ 1Sh111U(1 I1T W yAFA GAiW LSl18 L111 116LSty /..��V/LSU -LS 61XSU6ULS G.Ptw�IC —Xmmiq ms 71`IHi� IF'[tim mI c -- H 1STeeKA t (NOO¢MATIeNTn CF .. - �—�Uioy'1' -�i1s ter, r� Ot+rRh�witD 3� �hhacN • � •- . O_ MAW 13 Li �AjarNN Q l� - •�1 ILMfTTi �T[Yfa; 5LAKK vmS wiTw w►a,A 4a[Y � {y,T•s�,� i : �! � .� � � SNADiNb• 1' i t 11 � �� • Ae[A pea 70wN '7CRCA'i lo•'6Ci4"OPEN Ta wND N16Teticw4. � - - f16NnTUfI[L. I �I�I � � � HY4 PoS1S �Vn•ik-� - . rw es r,eweew WNI M Jesrrr .•reae•. �VA sv' rtl'N'w• PA r,a• �' w' ^'-w,. m •s Application to • f Old Kins s Highway Regional Historic District Committee d r� In the Town of Yarmouth for a D ZQ fir! 1 CERTIFICATE OF APPROPRIATENESS Application Is hereby made In triplicate. for the Issuance of a Cartificate of APprcPdalenese under Section 6 of Clupmr170. Acts and Resolves of M"aschusetta, 1973. lot proposed work as described below and on plans. d9 wings Of photographs accompanying Nis application for. Z; CHECX CATEGORIES THAT APPLY: I.Exterior Building Construction: ONew Building OAddition OAltaration Indicate type of building:0 House O Garage O Commercial OOther _ 1 Exterior Painting: O Y;= l Signs or Billboards:aNsw sign O Ex4tinp sign O Repathting aristlnp sign RI �., s. Structunc O Fence O WaII O Flagpols Unifier •��+ (pteue lead other side for explanation and re9uinmenu)• DATE May 19, 1994 TYPE OR PRINT LEGIBLY gray Farm ADDRESS OF PROPOSED WORK 108 gray Farm Rd. North, YF _ ASSESSORS MAP NO. 134 OWNER Townof Yarmouth ASSESSORS LOT NO. T—T NOMEADDRESS 1146 Route 28, South Yarmouth 02664 TEL NO. 398-2231 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Indude name of adlawnt property owners "=as any public street or way. (Attach additional Most if necessary). See attached. AGENT OR CONTRACTOR Tom Bharat TEL NO. 385-6499 ADDRESS 108 Bray Farm Rd. North, YP DETAILED DESCRIPTION OF PROPOSED WORK Giveall particutm of work to ba done (see No. fL other Nda),Irleluding materials to be used. if specifications do not accompany Plane. In the cue of signs, give locations of exist q signs and proposed locations of new sign. (Attach additional Meet. Y necessary). - - Bray Farm freestanding entrance sign C . Signed wMr-Cony -Agent t •rwwl•rGT,.n __ Received by H.O.C. Date S ,� The Certificate Ia hueby - ale Time u.el. t - By tA- ' YA :•ores O IMPORTANT: If Camficate is approved. approval Is subject to the 10 day provmed in the ACL IL:. rcvtc. O Pleases return to: Yarmouth HiaiGUc District Cotnntit:ee Town Hall. 114a W. 25. Scam Yarmouth. Mass. C2664 0 OF ► TOWN OF YARMOUTH Building Department B U I L D I N G '- PERMIT NO •_ 6-03-1076_ ' - PERMIT .%s. ISSUE DATE : _ _ 5ng/03 _ • : PRO OSED USE APPLICANT -TOWN OFYARMOUTH JOB WEATHER CARD . ADDRESS ;1146 Route 28 PERMIT TO MiscAent ------------ AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRICT R-40 SUBDIVISION MAP LOT BLOC 115124 BUILDING IS TO BE USE GROUP LOT SIZE CONST TYPE CONTR'S LICENSE O REMARK 40 x 40 tent - two pieces, 20 toot middle tent duration =9A)3-06/02/03. CONTR'S NAM ' AREA (SO FT) EST COST ($ $600.00 PERMIT FEE OWNE TOWN OFYARMOUTH ADDRESS 11146 Route 28 BUILDING DEPT BY INSPECTION RECORD FIELD COPY Date „ _ Note Progress - Corrections and Remarks Inspector ij �ECE�d'JE / I Permit # 7-: crcc p- 4 I6S ;Perm xp U / A�dt// lime date. U EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH - Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: T 6 months ,D3 -1o74 ASSESSOR'S INFORMATION: Map: / Parcel: OWNER: NAME PRESENT ADDRESS TEL. # CONTRACTOR: CWOra MORIgPOOM M NAME MAILING ADDRESS TELA esidential ❑ Commercial Est Cost of Construction $'v v Home`Im rovement Contractor Irc. # Construction Supervisor Lic. # P Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance ; . 1 Insurance Company Name: Worker's Comp. Policy# 0 J WORK TO BE PERFORMED YARhfOAPPROVEO J Tert (Fire Retardant Certificate attached) t,/ UM COMA{ Duration S 3 �. Q 3 Shed OK14 o -'�(s' ) ❑ Siding: # of Squares �/ ❑ Replacement windows: # % D X/,��0[ -,V l ee e s [I Replacement doors: # ❑Re•rooll #of Squares JojQ / m!"'rI� A'eZ7L O Stripping old shingles* ( ) going over layers of existing roof 'The debris will be disposed of at: Location of Facility I declare under penalties of perjury That the statements herein contained are true and correct to the best of my knowledge and belief I understand that any false answer(s) will be just cause for de ' or rev c- 'on of my license p for prosecutio under LAG.L Ch. 269, Section I. %applicant's Signaturr,• selo- Date: P- L s " lkw 053 IVIZVVners Signature (0 att Approved By: - Date: Building Official (or designee) Zoning District: Historical District: � Yes -AT\No Flood Plain Zone: ❑ Yes P No Water Resource Protection District: Within" 00 R of Wetlands: I — ❑ Yes Y 7�: Yes ❑ No Ryid I Tertificate of Name lesistance REGISTERED APPLICATION NUMBER P7002 ISSUED BY ANCHOR INDUSTRIES INC. Dale of Manufacture EVANSVILLE, INDIANA 47711 MANUFACTURERS OF THE FINISHED T2012 4/l/89 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are Inherently noninflammable) and were.*supplied to: NAME: Chase Canopy Co. CITY. Mattapoisett STATE 11 Certification is hereby made that: The articles described on this Certificate have been treated with a fleme4etardent approved chemical and that the application of said chemical was done Inconformance with California Fire Marshall Code, equal to or exceeds NFPA 701, CP.AI 84 Part 3.5.9 of CCC-C-428S (also Method of application: IMPREGNATED claneified by 11L F1ataahilitygnly as� Description of Item oertllled: 40 x 40 2pc. Sq. Bad Party Tent I Flame Retardant Process Used Will Not Be Nemovea t3y Washing And Is Effective For The Life .Of The Fabric Craniteville Comoany — Signed: Name of App"cater of Flame Restslanl Flntefi Craniteville, SC TENT DEPARTMENT—ANCKO-IF IN-15USTRICS INC. Louie Re Brown Tertifficatt of Niatme Resistancie REGISTERED APPLICATION NUMBER ISSUED By ANCHOR INDUSTRIES INC. EVANSVILLE. INDIANA 47711 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN Onto of Menufecture T8381 9=8-88 This is to certify that the materials described have been flame-retardant treated (or are Inherently noninflammable) and were supplied to: NAME: CHASE CANOPY CITY METTAPOISETT STATE NA Certification Is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code, equal to or exceeds NFPA y01, CPAI 84 PARTr3l--.9'.OF CCC-C-428E Method of application: IMPREGNATED (ALSO CLASSIPIED BY UL' PLAMMBILITY ONLY 354H Type, color and weight of aenvesllrinyl: 12 OZ. GALA GREEN AND' WHITE Description of Item certllled: . 20' MIDDLE FOR 404 TENT Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric in C"Iam• o pp ' lice r eru e e Reslstent Fln sh Signed: �, /C• ���ij d,,,,�.t, .4 T NT EPART M E —ANC H O R INDUSTRIES 1 Grp GRANITBVILLEr SC I LOUTS BROWN S*16N 'TOWN OF YARMOUTH Building Department BUILDING,---------- (508) 398-2231 ext.261 '-PERMIT NO FB-04-1183 PERMIT PROPOSED USE ISSUE DATE : 4/26/2004 APPLICANT :TaylorBrayFar,Preservation JOB WEATHER CARD -- ---• - ----= PERMIT TO Demdish AT (LOCATION) 100108BRAY FARM RD N ZONING DISTRI R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE demolish existing two story shed REMARKS CONTRACTOR LICENSE 0 AREA (SO FT) EST COST ($ 1$0.00 1 PERMIT FEE ($) $0.00 OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 1146 Route 28 South Yarmouth I MA 102W4 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector vacs are tr.F... 3 ems': EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 ASSESSOR'S INFORMATION: : Parcel: 2-9 on lij MIX a NAME CONIitACfOR 4w-vA73�Y F1 444 NAME ❑ Residential O Commercial rxratxr wnnxtss ReE•sE�l 77CW 5 Ste. P.o a Est Cost of Cotutruc tioe S C) Home Improvement Cathmaor lie K Construction Supervisor Liu M Watiattan•s Compensation Lwrcmoe: (dtcck am) ❑ I am the hornoowner ❑ I wn the sole proprietor O I have Worker's Compensation Instaanoe hsurance Company Nwna Worker's Corttp. Policy!+ WORK TO BE PERFORMED O read (Fire Retardant Catiscaoe Duration Wood Stove Shed DO'W-r=A-) 0 Siding: x of Sgoves windows: / D Replacement doors: I ' 0 Ro-root`. / of Squares () SkFPing old shingles• () going over Myers of existing roof rfhe debris wcTl be disposed of at: I declare under penalties of perjury tbu else statanmts betein eanaisedare true and coo. to the best of my knowledge sod belief 1 understand that nay &be sasw wse fa ill be just Cause denial or revocation of my lieea+e and for proseeahm wader KG.L Ch. 26S, Section 1. or(s) Applicant's Signatur. Owners Signature (or attacbmmt) Date: Approved By. Date: Building Official (or designee) Zoning District--&L , 9,!F- t istorical District �\ Yes ❑ No Flood Plain Zane: O Yes O No Woes Resource Protextion District: Within Ip0 & of Wetlands: ❑ Yes �No Yes ❑ No 101 Application to Old King's Highway Regional Historic District Commit ee' in the Town of Yarmouth fora yp 2 r 1. " 9 2 - • 22 CERTIFICATE FOR DEMOLITION O MOVrX, Application is hereby made in triplicate, for the issuance of a Permit for Demolition or Removal of a building or a structure or partthereof, raider Section 6 of Chapter 470, Ads and Resolves of Massachusetts,1973, for proposed work as described below and on Plans. drawings or Photographs accompanying this application for. TYPE OR PRINT LEGIBLY DATE 14A �'<2A 2 r% 7Z) U!J ADDRESS OF PROPOSED WORK 68 &W rv-.-., R.17./Jp.ASSESSORS MAP NO. /5/ owNER own 10 o/ AssEssoRs 1 oT No. 2�1 HOME ADDRESS R / ZS cSD. (4 o'2{q G[-q: TELETHONE NO. AGENT OR CONTRACTOR TELEPHONE NO v ADDRESS V r � - o USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS 0 2 DETAHZD DESCRIPTION OF PROPOSED WORK: If banding is to be removed, give new location. Snap shots showing all views of bunding mast accompany application. Use additional sheet, if necessary. Demo%z5h <e- z s--(ry -5hed d,6 isholvn �n a-ff ieCf �'h��s . IV sl'n ai Note: If approval is granted for relocation, a separate Certificate of Appropriateness is for cw location if within �. the Old King's Highway Regional Historic District /�/ 'i r� � �l �Q /A,A a ,ram Pm 1.. / Space below line for Committee use only. Received byOKHC " `'lu.;,;�)jlF, Date, This Certificate is hereby St L Date ` VUY Check M tt�j j By K0 s APPROVED O - UVIPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act DISAPPROVED 0 Please return to: Yarmouth OKHC District Committee Yarmouth Town Hall,1146 Route 28, S. Yarmouth, MA 02664 + wDOIA T j f 4 r• fit` li '; � .•,�,'� .` -;� •-' '� '.' •� ilk (� `{� _1 � r 1 � �r• may: Iti /, g•.iK". _ .. �. �... _ _ -• � �_ i .. t- _• �—.mow , •� • -� . ,.. _ .-Y�cw._ �.- .v��it:� �. ��.C'ti4 �,/Y �a• `�aY�`•_- �_ `l"T-Yw•r%�i •�N-s•'%-•a.' m,l' Sol Or r}: 161-24 _ ___ _ _ ___ __ _�� — ....,; TOWN OF DENNIS t~^ rt ' ti CREEK GARDEN 25 t � )� t; MAC n' +t 0, 24 �u 2MAC = woroMMM cl HOCKAN AD 57�,. v =} ASAC Z f � [/� • 0 V+� AC 102 106 • 660AC � 1 4 ••. 4� �,, - , 7J AC 70 w7 AG'" w AC AC { Crl .78 AC �•' I• SAE] ms ! J92A`21 UoA` 17 AC lAc u o3 V C "7AC O�V 1► '•i a14 ACO +C mAC 4 - �y O F� 7 A Ac 9�t0 �ae� As �� , �. 1 OF r TOWN OF YARMOUTH Building Department BUILDING off _ . _ _ _ , (508) 398-2231 ext261 '- _ PERMIT NO 8-05-431_ _ - - ; PERMIT -=-- K ISSUE DATE ;_ 9/2812004 _ : PROPOSED USE APPLICANT. Taylor Bray Fram Pres. Assoc. JOB WEATHER CARD ---------------------------- PERMIT TO pu e"ssory Structure AT (LOCATION) 100096BRAY FARM RD N (+108) ZONINGDISTRICTR 40 Bldg. Type: Resklentlal SUBDIVISION MAP LOT BLOCK 1151.106 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE construct four accessory structures for livestock & storage REMARKS AREA (SO FT) EST COST ($ $4,000.00 PERMIT FEE ($) OWNER I Town of Yarmouth BUILDING DEPT BY ADDRESS 11146 Route 28 South Yarmouth MA 102664 ME INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector r, W �ON ASOSSCWS REORMATION: SHEDS LESS THAN 150 SQ. FT. SHALL BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. Ws ,ORketheoob ., Fees , PermR expires 6 Months from issue date. BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Eat. 261 -71 map:! , / Parcel: !off N a RetidentW a canzmercisi 14?rr cv /¢ura EsL Cast of cuistraction i f ail Home Impmvemmt Cant actor Uc. f ConstructionSW=isor lk fl j10�'V — 8 8 fK Wotan s Campensafim h=xnmca (dwi me) ❑ I am the homeowner o I nm the sole proprietor o I have Warkees Compensation hnuiraooe Eosma>sce Cotpmy Name: Workers Camp. Policyff WORK TO BE PERFORMED o Teat (FreReWautCartiSateaCached) rhration Wood Stove swat O Siting @ of Sgwmes O Replact>oemt wmdowa N a Repiacemeat doors: N • R&vooE 0 of Sgmros ()StrippingoldthW=* G'`f'- /� /()goesovcjp IryenistiOfCXmrroof nU debris wiD be disposed ofat •%Ow/1 l//�%X tC644 lalf 4 i I derive, ender pennies ofperjtry that the Adcmeffi Iserei twvamed are true sad owed to the beat of my knowledge ml bdkE I underAmd tdst any false answers) will be jest cause for denW or revoation of w and ftr adder MO.L Ch.262. Section 1. cert'sS' Dda .1i3 /Y �snasSigrohae,(arattachmeot) � `� 7��7�D� Approved fir Data bAldiag Offieid (or dedVm) Zoning District iiWWncal District 12Y Yes o No Flood Plain Z40M o Yes 040 Water Re wrcie Protection District Within log R of Wetlands a Yes a No WYes a -No M butbor's ame of # . this is a =ner lot, rite in name stet r SHEDS LESS THAN 150 SQ. FT. SHALL BE PLACED A MINIMUM OF 30 FEET PLOT PLAN FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LO.T LINES.. FOR LOT # Indicate 3 aatwn of garage or accessory building Additions with dashed lines -------------------- f e]l�� disposal:( (cesspool) ® I(lot................ft. near) ' SIDE YARD REAR YARD A> SIDE YARD SET BACK a (lot..................ft. frontage) (NAME OF STREET) ti Infcrimation Supplied by 421t f / N -Fi6tI7 & 9{b "e k � Pyre !z •x 2q�l 1 �o• y CAP• 9 Cpro f� cHmkewiy"t shetp J� FIELD COPY BUILDING f �'01-cf$S- (o1LG�A'.a PERMIT ToFm of Yarmouth - - .- DATE June 26, 2001 PERMIT NO.: B—CK— 985 r - APPLICANT I Wn of Ynrmnl)thjDnn MrTntyt`ADDRESS 101 BriiQ Farm Read Y.P. 02675 (NO.) (STREET) ICONTR'S LICENSE) PERMIT TO damnlitinn (—) STORY NUMBER OF DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) 108 Rrny Fnrm Rnnd X_P_ 02675 DISTRICT R 40 INO.I (STREET) t a BETWEEN AND ICROSS STREET) (CROSS STREET) m SUBDIVISION iS11Z1► LOT LOT �Z—BLOCK j�111 13� SIZE u ' O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION' O Z III - TO TYPE 5$ USE GROUP IR4 BASEMENT WALLS OR FOUNDATION i (TYPE) O REMARKS: da8olItio8 of fr&4WA $Tears house AREA OR PERMIT iQ�C ---VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER TOua Of 4arm0nth / 'non ECTntyrn BUILDING DEPT.(`%��!V�'�f� - ADDRESS 1���Y r 09675 BY ,I { 1 DATE -03 INSPECTION RECORD NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR Of Y'tR ONE & TWO FAMILY ONLY - BUILDING PERMIT o�� APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department MATTKM! I 1146 Route 28 Yarmouth, iStA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 Office UseOnlyPlanning Board Information Assessors Department Information: =��- Qg� Plan Type Af a11 r Permit No. �ateo Endorsement Date Permit Fee $ 5a old New //ii Recording Date Deposit Rec'd. $ N 1&ate Plan No. 1.4 Property Dimensions: Net Due Other Lot Area (so Frontage(ft) Lot Coverage This Section for Office Use Only, Buildinq Permit Number: Date Issued: Signature: S� ET Certificate of Occupancy Buildin Official Date _ Is ' Is noty required Section 1 = Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: P—Koy 7W poP,^r Zoning District Proposed Use 1.3 Building Setbacks (tt) Front Yard Side Yards Rear Yard Required I Provided Required I Provided Required T Provided a' O to Water Supply (M.G.L. c. 40. S 54) 1.5 Flood Zone Information: Public Private Zone: _ BFE: Section 2 - Property Ownership/Authorized Agent 7-11 Owner of Record: Name (pri�) Mailing Address 2.2 Authorized Agent: Name (print) 385= Signature Telephone Section 3 - Construction Services 3.1 Licensed Construction Supervisor. Telephone Comments: IDt�tiuttll /d 3 g2.ri-Y ll%-� P-D. luo - Mailing Address �iAP.Acoa 7N10c7p--T' Not Applicable X Ucense Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name Not Applicable Address Ucense Number Expiration Date Signature Telephone 9 - 15 - 99 1 of 2 OVER • Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c.152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. 4 Signed Affidavit Attached Yes .......... No .......... /J ff Section 5 - Description of Proposed Work (check all applicable) New construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. _❑ Repalr(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. Type C4 Demolition t/ Other Specify: Brief Description of Proposed Work: Section 6 Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total =(1 +2+3+4+5) 7.Total Square Ft. (newhouses&addions) Section 7a - Owner Authorization -To be Completed When Owner's Agent 'orContractorA plies for Building Permit I, Check Below .Ir. i...(_ I.-•) ❑ Conservation -Commission Filing (H applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. ` Signature of Owner Date Section 7b Owner/Authorized Agent Declaration I, Io /"` cam` , as Owner/A thorizedAgent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name C of Owner/Agent /- O/ Date 9-15-99 2 of 2 of°fY"R�y TOWN OF YARMOUTH 0 �5 BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF �77;�,.,�,j or- Applicant: �O /"( �.LIJT^Y�'-� ,� G E7�T Building Permit -No.: n,, Address: `d3 Fr•-/ ��7�P-�G'iAE c Tel. No.: 3�S""� 7Date Filed: Bldg. Site Location:/68-4� F/be*4, �• Map No.: Lot No.: -S-1 moo! The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. -The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING - WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTIIIENT: Determines Compliance for Parking and Drainage. CONSERVATION COABJISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type - - - - - - •- - - . -= -=- - — . of -Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTDIENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The follouing Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: 1Ma_ ��1 / 511 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS - 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTbIENT: DATE: N/A: PLEASE NOTE': _..<.:, .:... .•:• :,... All stumps and/or brush must be disposed of at an approved site. C0M11IENTS: 8/99 Applicant Signature S4.9 Jn -.2 Date TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. job Location: Number Street Owner of Property: Construction Supervisor. Name Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. License No. Village License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the -requirements of MGL Ch.152 Yes /y.-- No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIV R: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owners Agent Owner ❑ Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: �> ,52A�OL f i 'l a,.i Est. Cost Address of Work l 6 6 OAF r t:;;J_R4 -t - Owner Name: 'r 6 e ,_ A� o f 7 /�"P--�`2 oy Date of Permit Application: T -- l — d ( I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties ofpedury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name t, The Commonwealth of Massachusetts Department of Industrial Accidents OlAce ollarestlyotless 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit a s a I a n t a l �: IC1tl.��. ,►. au • �r 1 am a homeowner performing all work myself. am a sole proprietor and have no one working in any capacity 0 lam an employer pro%iding workers' compensation for my employees working on this job. _.a., ess- insurance co policy $9 C3 I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: Failure to secure coverage as required under Section 25A of MGL 152 as lead to the imposition of erimisal penalties of a fine tap to 51rWAQ and/or one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of lnvestigadom or the DIA for coverage veri0eadoa. t )do hereby cnA der th ains and pt hes ojperjury that the injormadon provided above is true and correct I/C !—Q/Sionaturc ' AVI, f� 'f� Date � ` Print name O� c� T`��Cfc Phone M 3 8 �� 9¢ 07 official use only do not write in this area to be completed by city or town official city or town: YAR140UM ❑ check if Immediate response is required contact person: permit/license N nBuilding Department ❑I.Icensing Board 261 ❑Selectmen's Onnce ❑Health Department phone N; _ (508) 398-2231 eat. nOther Ironed 3,95 PJA1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their etttploy ees. As quoted from the "law an employee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An empl(tver is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the forezoine engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity. employing employees.- However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building_ appurtenant thereto shall not because of such employment be deemed to be an employer. %1GL chapter I: _section _5 also states that even• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into an• contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The afUdavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents office of IMMStlll311l8os 600 Washington Street Boston. Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 oTOWN OF YARMOUTH 3j . " ° BUILDING DEPARTMENT •.. ! 11 1146 Route 28 South Yarmouth NIA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT. DATE: JOB LOCATION:; d .'J.. /@ c STREET ADDRESS SECTION OF TOWN "HOMEOWNER"L6ij /1 T,�ti= 7�07 NAME HOMEPHONE WORK PHONE PRESENT MAILINQ ADDRESS /6 F&e=61 R2 l knl CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, ,provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. C HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. YesV,, No ❑ If you have checked ycs, please indicate_ the type coverage by checking the appropriate box. A liability insurance policy► Other type of indemnity ❑ Bond ❑ - OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Cha ter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of weer or Owner's Xgent Owner ❑ Agent ❑ h:h=eowvdi==p BUILDING TOWN OF Y A R M O U T H ELECTRICAL 1146ROUTE28 SOUTHYARMOUTH MASSACHUSMS02664-4451 GAS Telephone (508) 398.2231, ExL 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at /0 46 i� , l� Work Address is to be disposed of at the following location: Pahl o c-rm rSeoS4-c A94-Qft Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. S=/r6/ Date Permit No. I PLOT PLAN Abutbor r s Name Lot # If this is a corner lot, write in name of street. FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well 0 SIDE YARD FT (.lot ................ft. rear) .Q. REAR YARD ...... ..1.... ft. t HOUSE SET BACK I SIDE YARD 0---. FT� (lot..................ft. frontage) 13k-l� F,-X4q �>a . /J0 (NAME OF STREET) i Information Supplied by AbuttorIs Name Lot # If this is corner for write in name of a other �i street. 2f U71 on MARK NORTH POINT .. 5399 Application PP to 1,-,wi0l_1TH r,� Old King's Highway Regional Historic District �C�vvly CLERK `l in the Town of Yarmouth for a 2001 NAY 31 R1 D 36 CERTIFICATE FOR DEMOLITION OR REBMOOVALL D Application is hereby made in triplicate, for the issuance of a Permit for Demolition R�� I of a building or a structure or part thereof; under Section 6 of Chapter 470, Ads and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. TYPE OR PRINT LEGIBLY DATEn / mgu 9, a oo ADDRESS OF PROPOSED WORK W f�r'a a -arm ASSESSORS MAP NO. JET OWNER or UCcrnloj* ASSESSORS LOT NO. HOME ADDRESS Ole t? tWocYh TELEPHONE NO. AGENT OR CONTRACTOR do /11 e . A `F-t / i�� TELEPHONE N0 3 �� "q 4'O rl ADDRESS /d J !�' r^.-r-it f is / - "A21 - .J U U APPROVED YARhlOUTH co, ,!b11TTEpl,�}�Ily�l01 USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS OYHRD Y�JJ DETAILED DESCRIPTION OF PROPOSED WORK: If building is to be removed, give new location. Snap shots shoeing all %ic%�s of building must accompany application. Use additional sheet, if necessary. d :J &.ci •7d.- <46%t .4-hoC r 4-%1 e,1 Note: If approval is granted for relocation. a separate Certificate of Appropriateness is required for new location if %%ithin the Old King's Highway Regional Historic District SignedZZ' i 1% O vncr Contract r- gent Space below line for Committee use only Received by OKHC Date, . 6)1 This Certifica is hereby 1 a CheekBV APPROVED O �4011 AN If Certificate is approved, approval is subject to the 10 dad• appeal period provided in the Act. DISAPPROVEDE3 Please return to: Yarmouth OKHC District Committee Yarmouth To%%n Hall, 1146 Route 28, S. Yarmouth, MA 02664 F� os �� TOWN OF YARMOUTH Building Department BUILDING _ _ _ . (508) 398-2231 ext.261 6 PERMIT NO :: B-o6-„59- . P E R ISSUE DATE ; _ _4/912008_ _ ; PROPOSED USE .._ Q ----------------------APPLICANT .Barnstable County Sheriffs Dept B WEATHED ----------------- nERmrr TO Misc.Rent ' AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICTEO Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE= USE GROUP LOT SIZE O REMARKS erect temporary tent - duration: 04/11/08 - 04/14108. AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER OWN OF YARMOUTRTaylor Bray Farm BUILDING DEPT BY ADDRESS 11146Route28 South Yarmouth 102664 INSPECTION RECORD Date „ A , Note Progress - Corrections and Remarks CONTRACTOR LICENSE O PHONE FIELD COPY I -, Apr 08 08 04:13p Lynn McIntyre 5OM85-9407 p2 EXPRESS ASSESSORS DWMMATMN: UILDING PERMU APPLICATION TOWN OF YARMOUTPH YarmoutL BuBdinDepattmmt 1146 Route 28 South Yarmouth, MA 02664 (509) 399-2231 F.x. 261 Map: !s1 0-r 44,�5 SiQdcnW 0 coomeraal ESL Cod acc"u&uCom s Hoene Impravemet Cauft2or um s ,m)aw Sapd,; m Lk e Wod=xa's oageneaion f =m= (cbe*mc) no wo�k�ctGu �5 Gory�� +. 0 1 am fhe lnmeownc 0 I am the sole vgfficw 0 r have Wakrr s C=Pwatim Iostawooe -5�rPr 6 �; Prrf . 3emanoe C=puw Name: Waakd'a CQnpL pWicyd �'r� (FJrcRcW&wcm,scM WORK TOB$>i n n nwaaaa k,..sfi {, ,t y�� Woodsmvo sbea 0 Sidior 0 of SWmsa P 0 ReOmemew doors; • OReplaeaarae •' a c>tc�000E tafSgnwna () �°a °]d �• ()!� o+�a_hyecs afasime=mof MID debit WM be di.po.ed afar 1 ocaoau ofFrBtry I dwlw u mr deafalaf a armeso bum io ooasimd EMU=ma oacertm be bm afmy howl Jg. mcd Wid I wadanead &cr wy the emww(.) n _ mFices�e and d for paaaeaI'm n soda Idol. Ch.26k Secdm 1. App&ao]'a Ownew Skmft= ON ADro.aa By Dnc Boildia6OJ�eia1 Car daigaee) MsWcal DbW= D Yes � No Wamer P"mm a District:0 Yes -do-- blood Plain 7mc 0 Ya No Witlan 1w 9L ofWeBaadr. O Yes I A No 3A1 Apr 08 08 04:13p Lynn McIntyre 508-385-9407 4jar-81 z 8 h �uf U ptagdeu/ Alor. lit, A 5/(� Gva a he � �ncf c/K e r.Ja r�� � klk%er e- < 6 hb wr1, 5 Co wt vt 5 . -Are- rc(vroc'eauY a�-t . 4-0 y . Apr 09 08 10:28a Lynn McIntyre 508-385-9407 P.1 Zaa 8 o Gv h441 raj Ferri c G1 wCk%n,� Apr 09 08 10:28a Lynn McIntyre 508-385-9407 p.2 �At ,.Ap ►. 9. 24G8-10:11AIJ— so. 67.11 •- MAC 4. 20H 16:16aM BC""F g, IMPORTANT DOCUMENT CertificateOf fLau� �eSYS�Si?C� I5=0 BY pxtu of Shipnunt Z otsa %PPUCATMA �IUMBER � Tent Jdai1fu=ton EVANSVI1.M IMIANA 47M r�9m�o4 E121.4 MANUFAPTURERS OF THE FINISHED , 'PENT PRODUCTS DESCf=V HERETH This is to certify that the rnatertals described have been llerne-e•retardant treated (or are inherently norMnftanlmaAle) and were supplied to: TSM BARNSTABLE COUNTY CORRECTIONAL 6000 SHERIFF'S PLACE BOURNE NA02532 Certification is WOW made that The articles described on this Certificate have been treated whrn a ilama•ietardant approved chemical and that the apprieatton of said eharntcal was da�PA conconformance orm CPAs with Ca 1U9ma Fire Marshall Code. Ali fabric has been tested and passes ksGrIaI x "W►:otoeriplion of themcu fied: f WATOt2GWR40V4=VaM Flame Retardant Process Used Will Not 13e Removed By Washinlcl And Is Effective Far The.Life Of The Fabric 3.4oa9 eLE=TT 90 b0 Feµ *Gal OE29-5LE-805�t-6 TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO B----1159_ ; PERMIT ISSUE DATE ;_ ,4/92008_ _ ; PROPOSED USE _ _ _ . _ . _ APPLICANT .Barnstable County Sheriffs Dept ... * - 7 - - JOB WEATHER CARD PERMIT TO Miscltent I AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICTE0 Bldg. Type: Residential I SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE LOT SIZE erect temporary tent - duration: 04/11/08 - 04/14108. REMARKS AREA (SO FT) EST COST ($ OWNER OWN OF YARMOUTH/Taylor Bray Farm ADDRESS 11146Route28 South Yarmouth MA 02664 PERMIT FEE ($) BUILDING DEPT BY USE GROUP= PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDMSION RESTRICTIONS. CONTRACTOR LICENSE O MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING), 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT APPROVALS E FROM STREET 2 2 2 3 OTHEtg- f 1 2 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE. rs1 o< r TOWN OF YARMOUTH Building Department BUILDING _ .. _ _ _ _ . , (508) 398-2231 ext.261 PERMIT NO B:08-1159 ........ PERMIT ISSUE DATE _ 4J9)2008_ _ PROPOSED USE : APPLICANT :Bamsmble county sherfes Dept ' ' ' ' ' ' ' : JOB WEATHER CARD ----------------------------- PERMITTO Misc.ltent... AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 LOT SIZE erect temporary tent - duration: 04/11/08 - 04114/08. REMARKS AREA (SO FT) OWNER Fl ADDRESS 11146 Route 28 Yarmouth EST COST ($ Dr Bray Farm BUILDING IS TO BE: CONST TYPE USE GROUP PERMIT FEE ($) BUILDING DEPT BY YOUR SPECIAL ATTENTION is called to the following: PHONE CONTRACTOR LICENSE 0 This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this Jurisdiction including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit is Issued must be displayed on premises. The Department must be notified and Inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimum of three called Inspection, namely, 1) Footings, drain file systems, foundation and basement wails, when walls are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanical systems are Installed. 3) Final inspection when building or structure is completed. On jobs involving reinforced concrete work, Inspection must be made after steel Is in place and before concrete is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been inspected and approved by the Department in accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee Is also charged predicated on the extent of the variation from the original plans. Permits are not valid H construction work is not started within six months from date permit is Issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been Installed. Painting or decorating Is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY TOWN OF YARMOUTH Building Department g U I LDI (508) 398-2231 ext.261 PERMIT NO ; _ 13-08-1290 _ w A ISSUE DATE : _ _5/7t2008_ _ : PROPOSED USE PER'V' It APPLICANT CHASE CANOPY OB WEATHER CARD PERMITTO TENT AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE REMARKS ERECT TEMPORARY TENT - DURATION 5/30/08 - GW08 AREA (SO FT) EST COST ($ $980.00 PERMIT FEE ($) $0.00 OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH YARMOUTH PORT • I MA 102675 INSPECTION RECORD Date Note Progress - Corrections and Remark Y� CONTRACTOR LICENSE F— P. 0. BOX 46 MATTAPOISET MA 02739 PHONE 15087582055 FIELD COPY OF ' P TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ , (508) 398-2231 ext.261 PERMIT NO :B:o:�-,moo_: ......... •• ------ ISSUE PROPOSED USE PERMIT �. DATE ; _ _51712008_ _ ; ; APPLICANT CHASE CANOPY --------------------------- JOB WEATHER CARD PERMIT TO TENT AT (LOCATION) 10108BRAYFAFM RD NORTH ZONING DISTRICT= Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 115124.1 LOT SIZE O REMARKS BUILDING IS TO BE: CONST ERECT TEMPORARY TENT - DURATION 5/30108 - 6/2/08 AREA (SO FT) EST COST ($ 980.00 OWNER ADDRESS OWN OF YARMOUTH PERMIT FEE ($) BUILDING DEPT BY 0108 BRAY FARM RD NORTH YARMOUTH PORT MA 102675 'E 5•B USE GROUP R-4 CONTRACTOR LICENSE 0 P. O. BOX 46 MATTAPOISET MA 02739 PHONE 15087582055 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS. 2 PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL PLUMBING/GAS AND MEMBERS (READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. COVERING) 3) FINAL INSPECTION BEFORE OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4) REFER TO DETAILED INSPECTION BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS 2 2 v 2 3 OTHER— / 1 2 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE. os r TOWN OF YARMOUTH Building DepartmentN BUILDING (508) 398-2231 ext.261 PERMITNO 8-08-1290_ ISSUE : ( PROPOSED USE PERMIT DATE :::5%7�2Q�8_ :::::::::: APPLICANT CHASE CANOPY ----------------------------- JOB WEATHER CARD PERMIT TO TENT AT (LOCATION) 0108BRAY FARM RD NORTH ZONING DISTRICT Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE ERECT TEMPORARY TENT - DURATION M0108 - 6t2/08 REMARKS AREA (SO FT) EST COST ($ OWNER ITOWN OFYARMOUTH ADDRESS 10108 BRAY FARM RD NORTH YARMOUTH PORT & PERMIT FEE ($) BUILDING DEPT BY YOUR SPECIAL ATTENTION is called to the following: CONTRACTOR LICENSE O P. O. BOX 46 MATTAPOISET MA 02739 PHONE 15087582055 This permit is granted on the express condition that the said construction shalt, in all respects, conform to the Ordinances of this Jurisdiction including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit Is Issued must be displayed on premises. The Department must be notified and inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimum of three called inspection, namely, 1) Footings, drain file systems, foundation and basement walls, when walls are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanical systems are installed. 3) Final inspection when building or structure is completed. On jobs involving reinforced concrete work. Inspection must be made after steel is in place and before concrete is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been Inspected and approved by the Department in accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee is also charged predicated on the extent of the variation from the original plans. Permits are not valid If construction work is not started within six months from date permit Is Issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been installed. Painting or decorating is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY os r TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ _ _ _ _ (508) 398-2231 ext.261 PERMIT NO �=B-o8-,289_. .. PERMIT ISSUE DATE K ; _ 5/6/2008_ _ ; PROPOSED USE ; - APPLICANT Bamsta6feCountyShenift'sDept J B WEATHER CARD PERMIT TO TENT AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 15124.1 BUILDING IS TO BE: CONST TYPE 5-B UjeqU R-4 LOT SIZE ERECT TEMPORARY TENT - DURATION : 5rOW - 6/2/08 REMARKS CONTRACTOR ICENSE O AREA (SO FT) EST COST ($ 0.00 PERMIT FEE ($) OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 10108BRAY FARM RD NORTH YARMOUTH PORT I MA 102675 PHONE INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remark Inspector s d EXPIi CONS RUCnON ADDRESS: /oe5 ASSESSOR'S INFORMATION: Owm3t �OGJ/1 G NAME CONTRACTOR.'crhs% Penh.., !Fecf C/ i Permit expka momhr tram issue dolt S BUILDING PERAHT APPLI T�OI �1 TOWN OF YARMOUTH R E C I V E D V Yarmouth Building Department 1146 Route 29 MAY 0�\V2P8 South Yarmouth, MA 02664 (509) 398-2231 Fxt. 261 BUILDING DEPT. B,: Map: 1 SI 1 PN=L. 0 Q Residential ❑ Com=tw Est. Copt of Ccmtrocdm S Home Improv=cd CootractocIdc.! Camtrnctim SupaviiorI W&lMWS Compeoswm Imt == (check ❑ I.m the homeowna ❑ I am the wk proprietor ❑ I here Wo&Ws Compettsetim Insuratta SR errr '{ S j,L frf Insurance Compwy Name: Worker's Comp. Policy! /' WORK TO BE PERIroRMED ta'Teut (Fie R4wdsstCa6ficus J an Z wood Score Shed a SidmC 0 cf Sq� a Rq$scw mt wbkbwx # 0 Rc$wcmcnt doom O Raroot = ofSq== () SUWft atd dd28W - () Pft ore* b7m dexktna root 'The debris wM be dirposed dot: Lmod n offmc tt I dcdae adder pemhics ofpe deny that the stuemew I I codaiotd we hoe sod coned to me best deny Iaowkdgc and bcW I osdastsod dw my Tabs suswes(s) will bo just came for denial or... of my Gceose sod for -rase, " coda M.U.L Ch.26& Section 1. Apptica rs Six - Owoess Siputme (a Appmred I3y Due: ItWI t OIDcad (or daipm) Zmiq Distric ifiigorial District B/ Yes ❑ No water Resource Protection Dist&t ❑ Yes ❑—No Flood Plain Zones ❑ Yes within 100 B. of Wetlands: ❑ Yes tf No PPROVED MAY 07 2008 KI �tMPORTANT DOCUMEt�t�i' �1 �' . • •cate ISSSUED BY EG1SMMON Dtto of sldpment - APPUCATION otuo6�o1 !lUIIBER . wusr EVANSVILLE, INDIANA 47725 Tent IdenlNuatian MANUPAMSEM OF THE FMISNFO nziA TENT PRODUCTS DESCRb» HEREIN , This is to certify that the materials described have been dame retardant treated (or are inherently noninflammable) end wero supplied to: 76M BARNSTABLE COUNTY CORRECTIONAL s= SHERIFFS PLACE BOURNE MA 02532 Certlrleation is hereby made that, yhe articles described an this Ccrti icate have been treated wtth a tlame4etardant approved chemical and that the appUcailen of said chemical was done In conformance wkh COMM" Virg Lisrehal Code. AN fabric has been testad and passes NFPA M-99. CPAI $4, ULC 109. Sarhll rtatleop) Description d ttern Ctrt(Ged: . V=ATM25m40WH=%?M cim . m Oeforriant arritMs Used Will Not Be Removed By �p��TTi+u"r PT.f • i�•'•.�'o:t,�>'•';_'1'1�1.:2�i� �'J.�R-C�rS.(eL.[.�: Of The Fabric NL ;•d 0E29-SLE-GOS-1-6 J3089 eLE=TT 9D i0 Sam EXPRESS WELDING PERMIT APPLI YARMOUTH Yarmouth Building Department 1146 Route 28 South Yazmouth, MA 02664 (508) 398f-2231 Ext. 2261 L CONSIRUCIION ADDRESS. ! P98� Ab• f 111 0,y ASSESSOR'S RgFFORMATION: eR; Town � C.0MRACMR.dA Map: !s! Para): s�- % .eox 4G .Fermitt6— Fee S j Permit spin 6 mmttn noon Issue dde kTJQ1-'IVED Fm AV 2008 BUILDING DEP T aY' 43 tsia idmtial ❑ Commercw Est Cost of Construction S • .��•yo Home Impwemmt CoatMc UQ / Construction Supervisor Uc. ere WorloaWs Compensation Ins (check one) 0 1 am the homeowner 0 I am the auk pmpti tm EY I hat Workcea Comm lmmnw e bswwoeCompanyName. Sew a#,,—e Lew SAee�Lworwscamp. Pow WORK TO BE PERFORMED Am ' - (FkeReterdutCartifkaee Iaastioa�cfvn Z Wood score sled a Si&W i of Sgowcs a Replaeemmt windows s 0 Replaeemmt doors 0 0 R"wE d ofSgw= () Stripping old ddngkO . () vAng ova lapels of exbslmg roof wM debris will be disposed ofat location of Facility I declae render pemk n ofpepuy mat the atoms betem omhiaed ate true and - - - lo the bat ofmy tnovlodge and belie[ I andasto d flit soy false amswu(s) will be just none far dadd or revoeatim of my faxme and for prasaxmoo udw MO.L t2L 2% Section 1. Appliesot'a OwOas s4matiae (or G App owd By: Dd= BwldwgOfl]dd (or &sip =) _ Zoning District Flo NbIlorical District ❑-Yes 0 No Flood Plain Zone: O Ycs B- No Water Resomx Protection Within 100 It. of Wcdandz 0 Yes ❑ 0 Yes ❑ANo MAY 07 2008 3101 GHWAY 04/29/2M 15:12 NOX41 002 _- 46-28-2008 TUr 01:08 M berry Insurance�54p 1LFAX NO. 15085206914 F. .— DATE (►uioarr") I oBP -CERTIFICATE OF LIABILITY INSURA WCE oz 2910 �gvuCEP TNIB CERTIFICATE IS I98UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FUGHTIS UPON THE CERTIFICATE HOLDER. TWS CERTR IFICATR DOES NOT AMEND. EXTEND O 6esrp Ynearanl:e bgaaey ALTERTIIECOVERAGEAFFORDS"yTHEPOLICIESCFLOW. s train Street I franklia WA 62030 phOnOLeOQ-e]4-5701 >rass60S-S]0.6914 �- INSURERS AFFORDING COVERAGE INA N6UIt0 N3URCAA CCmoaerCe IMOOranCe Cc p,SUREAW 6/ vast rive I Red Sa,. Co. -- Chaela CaaRTLo Company, LLC *4UReaC: 6 hOleaala Retail S Imo_,_--- taNalek��6a rie P 0. 80f 4L6 INSuIIeRV I— mattap ieatt xi Wif I INSURERE' I : COVERAGES Thf POI.1CJJ OP INSURANCE LISTED DEWR I4 NE 199M UISUCO TO TNI: WSUKO NAMED AIOVR FCA TK POLICY 461Y AE:1UIRf MENT. TERM OR CONDITION OF ANY CONTRACT OR OrOM OOCUU&T WITH REIPEC'P TO WINCH TA LIAY PC\TAiN. THE NS:IRANCS AFRgROEO OT THE F�OLICIES DD2GREi W NEREIN IO EU91ECT YO AU. TM!'IERMS ! AOUC6S.ACOREGATELIMITSSMOWNMAY HAVFEEENPE000EDOYPAID CLAIMS. �1 � ' GINIRALLIASILRY g ' RcommrRCIALwNeR.LLNe1Lm i CY00]1166E � CLAIMt MAPS Lj OCCUR I ' W GIxL AecR20ATl' LIMIrArPLles PER: ►amy M 78T pine I AUTOMOSILE �JAEILRT A I ANY AUTO 107>�SlIARWCx ALL OWNED AUTOS I 7L schEOULL'OAUTOS X MRED►=3 �( AON•aWNEO AUTOS 1 CiAM08 LlADlu" i IF I AgYAUTO ESGE6E41MIRGLA UAYILRY OCCUR C CLAINI VA09 1 ; RETENTION 6 VLORNERS COMPENSATION AND C I EMP60WIIs'L4AP1LITY . 1PC000991-7 ANY PRO►R16TONPARjj1VtRIEk6CU7Nf OFyL46ICERA}MDOR akrAU0E77 , ePECdPApYIL I.ONe hover , S Isquipmant alosCer (CZ00210484 07/06/07� 07/06/02 MED EXP Ian PGRIONALR 'CfiNERALAC I aCnmYT'E. LIMITS o Lilac), «.orwnl Is5,00 IOVNAIRY s1,00 IRELATE� Ili 00 :7LLP�•AgG � 61 .00 COMOINEOSWAELI4R IIl,900,OGO I 05/21/07 i 05/22/01 KjC1dmnII —� I! �PINcm 1 I I l�OpiTWOifIIjY IS 1 I --I �a'ao�uvN10AMAQE ' S . I � AUTO ONLY •!AACCIOfNrt ' EAACC S 2mlry AOG 16 _.. EACH OCCURPINCE ACOREGATE Sri x o YL s I I Oi/Ol/06 I O1/01/09 .re—.L.rAACHAArrm rw L 100,000 E.4O16e1 11SE•EAEMPLOY !1, 100,000._... I I U.OISCASt • POLICY LkkT L,, si - 07/09/07I 07/06/01 $0000000 Lim:t I 91.000 Dacar. proot of Coverage. Ras Shoop Shooting hanotit get -Up 5/30/00, event 6/l/0e, nick -up 6/2/02 MOLDER CANCELLATION Ti1YbORp DNOvLOANYQFTMIAPOVEO96CRIDtOPOLPE321CARCELLEDDvORETHE 11:SA"c OATETIIlLED►,TNffsS'j"PQURERWKLENOtAVORTom^ 10 DAT.{wnlrr's MOTk:E TO T1R CDRTIAGTL NOLOtJ4 NAMED TO TNf LEPT.IUT IAIL'JFE M C'� • ?hw.• MF=g Pq O&WATION OA LIABWTV OF ART KIND UPON YMR INIUNtR..: •. A3:• =.ih Taylor preaarvation Aeacc. RaPRaIENTATIYEs. 108 Bray rarm/ Masth Au 1��p�� TA V&=09thport KA 0767S * VLW OFN IMPORTANT DOCUMEIVT��---- Certificate of Plante Resistance REGISTRATION'S BY Data of Shipment APPUCATIoN • 3112=07 NUMBER EVANSVILLE, INDIANA 477W Tent identification MANUFACTURERS OF THE FINISHED 0aazau F4t3.0E TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 256M CHASE CANOPY COMPANY 4 NICKYS LN P O BOX 46 MATTAPOISETTE MA 273904013 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPA] 84, ULC 109. Serial # 31 aamc I61 I Desaiptien of item certified: CENT ti11D JON' X 20 FQtR 701 Flame Retardant Process Used Will Not Be Removed 13y Washing And Is Effective For The Life Of The Fab ric ��% rraR�e ReTr=rI JLWVtR_rnivna FR.ury _ Signed: - ! /'t' [-SC�je Nana of Aoolleeeeor of Flame RRsis/m t Rnish ANCHOR MDUSTRIES INC. b 8 os r TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ _ . _ _ , (508) 398-2231 ext.261 PERMIT NO :B.o�-,�». _:-; PERMIT ISSUE DATE.4/1/2008_ PROPOSED USE APPLICANT _ ... Iu.... RE . ............... . � OB WEATH �A D PERMIT TO s11@�J AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT= Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 115124.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE — ' SHED 10 x 14 REMARKS CONTRACTOR LICENSE AREA (SO FT) EST COST ($ 3,000.00 PERMIT FEE OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH YARMOUTH PORT MA 02675 PHONE 5083859407 INSPECTION RECORD FIELD COPY Date Q % Note Progress - Corrections and Remark Inspector �- SHEDS LESS THAN 150 SQ. FT. SHALL BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. EXPRESS WELDING PERMT AP] TOWN OF YARMOUTH a� Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 26/1 $ b CONSTRUCTION ADDRESS: zOay pp 5apu /mod• Z)6. %JQ � ASSESSOR'S INFORMATION: 7��� Map: ! Sl Parcel: 24 OWNER: TGJ,n O:C g4LN4IOUT 4 NAME I PRF_SFhrr AnnRFCC CONTRACTOR 7'z,- ergs M Permit # I1 Fees 1ru A� Permit expires 6 mm from issue date. APR 0 12008 BUILAGT�PT. r, rt 0s�4AG ....n,� rwnuar+uAuuKtbb I TELa t5De, 386-, �ef07 0 Residential ❑ Commercial EsL Cost of Constmcdon S 3 00d ;- 6"D Home Improvement Contractor Lic. # Construction Supervisor Lic. # Workman's Compensation Insurance: (check one) 0 I am the homeowner ❑ 1 am the sole proprietor ❑ 1 have Worker's Compensation Insurance X% R Insurance Company Name: Worker's Comp. Policy#_ WORK TO BE PERFORMED 0 Tent (Fire Rchudant Certificate attached) Duration Wood Stove Sbed__t/ ❑ Siding # of Squares 0 Replacement windows: # 0 Replacement doors: # ❑ Rc-roof # of Squares () Stripping old shingles' () going over layers of odsting roof a•ILe debris will be disposed ofat 46LrRt ad -A /A>Lr �f AAA AA//ri4.ii�r}b.r [ ! iN I declare under penalties of perjury that the statements herein contained am true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or jevocation of my Gceppc and far prosecution under MG.L Ch 269, Section 1. Applicant's Sigortute / l e" Data Owners Signature (or attachment) f Date: Approved Br., DaL- Building Official (or desigae) /Zoning District / Historical District: ld Yes ❑ No Flood Plain Zone: 0 Yes IYNo Water Resource Protection District Within 100 tt of WeU�ds: ❑ Yes (/No ❑ Yes IY No 28 , Zdoff 3101 The Commonwealth ofMuss�tusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Bullders/Contractors/Electricians/Plumbers Name Address: V Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time)' 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required) t have hired the sub -.contactors listed on the attached sheet. These sub -contractors have employees and have erorkers' comp. insurance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' coma. insurance reauiredl Type of pioject (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other, Any applicant that checks box It must also fill out the section below showing their workers' eon ensation policy information. t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractor trust submit anew affidavit indicating such tContractors that check this box must attached an additional sheet showing the none of the subcontractors and state whether or not those entities have arployces. If the subcontractor have employees, they must provide their workers' cone. policy number. I am an employer that Is providing workers' compensation Insurance for my employees Below is the polley and job site Information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $150.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OfLce of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above Is true and correct. Signature: Date: _ Phone #: use only. Do not write in this area, to be comp eted y city or town ofJiciaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the . receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the Issuance or renewal of it license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for, the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confurnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the avvrooriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would Ile to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia r r but=' a Me at / ? this is a �acner late rite in name atseet. r PLOT PLAN • FOR LOT # indicate location of garage or accessory building Additkm with dashed lilies ------------ --- SeMerage dispowd (cesspool) 491 Kell 0 I I(�..... •.... •.....$. Imo) ._ REAR YARD • ........,...eft. SIDE YARD (lot..................ft. frartaw) (NAME OF STREET) Af � , •f an / Informati MmnUad by SID8 YARD YnnA11 RMOUTH ty 61, ll; �y d Kin -s Highway onal Historic District Co�tt�`i ('I ERK O in the Town of Yarmouth for a 2918 FEB 29 PM 27 444 CERTIFICATE OF APPROPRIA7 EC E IVED Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,1973, for proposed work as described below and on Plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THATAPPLY: 1. Exterior Building Construction: 4ewBuilding • •Addition • •Alteration Indicate type of building: • -louse • Garage • Commercial • Other 2. Exterior Painting: 00 3. Signsor Billboards: --NewSign - Existing Sign • 4tepainting existing sign 4. Structure: • eFence • •Wall •+Iagpole • Otber TYPE OR PRINr LEGIBLY DATE: Feb, 4i Zv O 8 ADDRESS OF PROPOSED WORK Yf0j3 8%''lQlN�r /�d • �No . ASSESSORS MAPNO.: 151 OWNER: J c o Ua rut oyT'!'I ASSESSORS LOTNO. ! HOME ADDRESS: TELEPHONENO- AGENT R CONTRACTOR —tb n M C _rn 36re- TELEPHONE NO_ 5�19- 385- !24o% ADDRESS:_ 103 Rr4t4 Fan" PJ• A)Up 11 _[—r{7 07,-4, -7 USE ATrACHIDSHEETINPAC ETFORABITI7WGOWNERS DETAH.ED DESCRIPTION OF PROPOSED WORK: Give all particulars ofwork to be done including materials to be used. In can of signs, give location--sLLof existing signs and pwpossed locations ofnew signs (attach additional sheet, ifnaesivy) 1 $Vl�of 0. G16n%Gr �OCLT jhe-d -Usln9 Z 'xLf ' d0,,76-7"UG;fi0r7 red c e Pa,r rb v-� r wh i -fe cedar 31 efee� ap., colon r aj r 4 -f'r'livl. �YjliGtl✓raj �IZe !p �iG /�i Signed — Own Contractor -Agent Spar below line for Committee use only. Received by OKHC Dat&/1) 1�_This Certifiate 208 2008 YARtAIU fH LD KING'S HIGI IMPORTANT: If Certificate is spprmyed, approval is subject to provided in the Act Plean retran to: Yarmoudi OKHC DistrictCommhuw Yarmotd 1146 Route 28, S. Yarmouth, MA 02664 RECEIVED YARMOUTH LeANG'S HIGHWAY g- 40a3 3. A 4. I agree to the above conditions - Owner/Al Signature APPR EVO D I FEB 2 8 2008 Signature C/k — TOWFH tr r! _ 2�It 8 FEB 29 PM VED FEB 2 8 2008 \ P%-oPo3¢d - dankeyd jocli ex1s ng chicken C0000p4pran S i P/of Plan 5hoc�,r�g Propo:�-� donkeyshcd a'- Tau/or-Bray Forni `llarmou�h Por . Feb. 4, 2008 6,Ale . I'- 1, r � � PcFSfurE / f Qp?QOQ 16 �� eeet l2�-� —1 �i (pie \ljar/,o >0 777. �W," T-e .A- . ...... . —T--T r- I I rr PS-L ...........'I i I .......... I ............................ .... ..... . .......... .... . ...... . . ..... .. .. ... . ......... y 4povi _._.. ......_...... ... _.. � \rig. _-__. . �j¢rZrloJ��o2 r T ) le ,,V'5 C a(N �ja �j P S iLG sCAW TvgC- rz(7n. i CnaNJ a� •YAR t v vv 11 yr Y tiniviv U 1 n �a or �y BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 APPLICATION FOR SIGN PERMIT Date hq 3 /Zoe _ p;.l Permit No d'3, Location / Address for proposed signI $rVy FAIWI 50 . Assessor's Maprotorring District B l_�2_�3�Res-__jTist.Dist Name of Business for proposed siga(s)_ lG+t,/!or bray l't�-fit f`J �s �SSo� , Name(s)of Business owners) , Nlailin Address of Business own P" G • G , g ers) - Arl'1� Ru i /Lid 67U Business Owner(s) Phone: Business Hnme Name of Building Owner(s) Sign Builder Address: Type of Conshuction internal Light External light Applicant Instnictlons: •Applicanf must attach a separate 8 %"x 11" sheet including two diagrams: A) Design, dimension and colors of the proposed sign(s) B) Location of the proposed sign(s) with setbacks from property lines that are at least 6 feet per code. Application for attached sign must show running footage of portion of building frontage occupied by business. F r Felj Fe,341 VA4 a f Fj-(r Freestandine Sim(s) Size of proposed Standing Sip(s) is: Attached Sloi(s) Size of proposed Attached Sign(s) is: Temporary Slen(s) Size of proposed Temporary Sign(s) is: 2 c X 2 ` Date of proposed Temporary Sign(s) is: f , Zo o S f 3d Zak All Permits are subiect to the approval of the Sign Inspector I Hereby Agree to conform to the zoning by-laws, section 303 of the Town of Yarmouth regarding the above sign construction. I further agree that this sign will not be altered, added to or changed in any way until a new permit has been granted. The number of this permit will be affixed to the sign in no less than Ve numbers. Sign Permits are not valid until the Building Commissioner issues Use and Occupancy Permits. Signature of Applicant: e, Signature of Building Owner(s): WDate This Permit Replaces # Approved by: With the followine conditions: IMP g5100/ os TOWN OF YARMOUTH Building Department BUILDING _ , , (508) 398-2231 e xt.261 PERMIT NO : _: :B-,aass - ------ _....... PROPOSEDUSE PERMIT ISSUE DATE :,10/13/2009_: APPLICANT �ynnMciruyre :::::::::: r: - - - - - JOB WEATHER CARD PERMIT TO MiscAeru permit ; AT (LOCATION) ZONING DISTRICT R 40 Bldg. Type: Residential 10108BRAY FARM RD NORTH SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE = USE GROUP O LOT SIZE REMARKS erect temporary tent - duration: 10116M9-10119/09 AREA (SO FT) EST COST ($) $0.00 VITIT E ($) $0.00 OWNER OWN OFYARMOUTH BUILDING DEPT BY ADDRESS 10108 BRAY FARM RD NORTH Yamrouth Port I MA 102675 INSPECTION RECORD Date Note Progress - Corrections and Remark PHONE CONTRACTOR LICENSE O FIELD COPY OF r TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ _ _ _ _ . (508) 398-2231 ext.261 PERMIT NO �_B-10-1423_� --__; PERMIT u ISSUE DATE ; _ _6/9/2010_ _ ; PROPOSED USE ; . _ _ _ APPLICANT,Bamstabl8CountyShenffsDepartment JOB WEATHER CARD ............................. PERMITTO l isc.ltemporaryten( AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICT Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE= USE GROUP= LOT SIZE O erect temporary tent - duration: 06116110 - 06117/10 REMARKS P AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER OWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146Route28 South Yarmouth MA 102664 INSPECTION RECORD CONTRACTOR LICENSE 0 Bamstable County Sheriffs De PHONE 150839W231 FIELD COPY Date I Note Progress - Corrections and Remarks I Inspector CS F S�4 TOWN OF YARMOUTH Building Department BUILDING _ _ (508) 398-2231 ext.261 PERMIT NO 8-10-1446_ . - - ; PERMIT .Cats i) ISSUE DATE ; _ 6M4/2010 _ ; PROPOSED USE _ . _ _ . _ _ APPLICANT chase Canopy - - - - - - JOB WEATHER CARD ----------------------------- PERMITTO PiscJirr; oraryten( AT (LOCATION) 10108BRAY FARM RD NORTH ZONING DISTRICTEE Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1151.24.1 BUILDING IS TO BE: CONST TYPE® USE GROUP R-3 LOT SIZE REMARKS erect temporary tent - duration: 06/11/10 - 06/15110 AREA (SO FT) EST COST ($ PERMIT FEE (1, OWNER ITOWN OF YARMOUTH BUILDING DEPT BY ADDRESS 11146ROute28 South Yarmouth MA 102664 INSPECTION RECORD PHONE CONTRACTOR LICENSE 0 Chase Canopy Company, Inc. P.O. Box 46 Mattapoisett MA 02739 5087582055 FIELD COPY Date I Note Progress - Corrections and Remarks I Inspector 9 Jun 08 10 06:39p Lynn McIntyre 508-385-9407 p.2 FjUN C��� Dtmsa0 9 2010 t o /9v PemLitFOBS DINGDEPT P+amit ex tes the loom ;�*• ante. . EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Banding DepartmentD r ; 1146 Route 28 , South Yarmouth, MA 02664'=ar T�Q (508) 398-2231 Ext.1261 CONSTRUCTION ADDRESS: �t) �I2ti7 L4-i ii 19/J ASSESSOR'S INFORMATION: Map: Parcel: OWNER:-_ -Ioyo/ NAMV Q PRESrNtADDRESS Tf]- a CONTRACTOR: f CST-)'• �Yr� rN! tTr� l+i" �%B " ✓%✓ C�D NAME I MAILING ADDRESS TEI_R Residential Cortuoerrial Est. Cost of Construction $ Home impr ovemenr Contractor tic. A Construction Supervisor 13c. ut Workmarl's Compensation Insurance: (check one) I am the bomco%mcr I am the sole proprietor I have Worker's Compensation Insurance %) G Insurance Company Name Wodcer's Camp. Policytf WORK TO BE PERFORMED Duration ^ Jr'. Tea[ t [ire Retardant Certificate attar.hod) r .� it � Wtwd Stage Shed �. Staing: t of Sgmrea Replacement Replacemew doorReplacement aiwiwindows:A f Re -roof: tr of Squares () Stripping old stdngler () gala& o.rr_Ia)ws of ousting roof Old Kings XSbway1 fismrk District RoofirlySiding (Like fiw Like) Me debris will be diWsed of at: Lnrsdon ofFaciIIry [ declare under pcnaltics of perjury [hu the ststemenes herein curtained we true and tones[ to the best of my knowledge and belief. I understand drat my false answer(s) win be just ewise for denial nr ation of ray ticenrc for prosecution coda M.C.L (2L 26L Section 1. C �ti Applieaat's YgnaanC Date Owners Signature (or o qv— AMmvcd fir, Building Oducw (or dcsigne c) - Zoning District-_ Historical District No Flood Plain Zone: Yes h� Water Reworce Protection District Within 100 !L of Wetianc(s: Yes Yes NiI_- Jun 14 10 03:33p Lynn McIntyre 508-385-9407 p.1 y r O� CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: OWNER: 1 Urnot LneUwy Pwnit# � � irts 6 rmotltl fivnt EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 40r. ,,) South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261��' O Map: Prtteej: 11MIL ( t'R1SSFNTADDRFSS 'Ifs- s CONTRACTOR: J>�i7O�Q v �� 10u P0.60y -4 INI a ff"b m e-( - �d 8' 758— Z05� Residential Commercial FsL Cost of Construction $ Home In vrovement Contractor Li: A Construction Supervisor Lic. # Workman's Compensation Insvrance-. (Check one) Ian the homeowner T arts the sole proprietor 1/I have Worker's Compensation Inwranee Insurance Company Name: Worker's Comp. Policy# WORK TO BE PERFORMED Toot tfire Retardant CatT=te suadad) Dtuadonl/ z1z?4e—A= /7 t/.jrle /,O WoodSww S3ed sidin.*: # of Replxement R4rnfo�vs: tr Stplarcx- Replacement doors: If - Rt-m-&- f of Syaaa:s () Stripping old shingles' (I going oviz__Jkvcm of existing roof Old Kings HlghwayfHintoric District Roofiagfsidiag alke for Like) 17M debris will be disposal of at: incatiun of I acility 1 &)clue ceder penalties of pajtay that the sw ntetu h=ia C 02Wa;A tar true and sondes to tlr best of my tnowedge aodbdieL I understand that any false aawals) willbe just ease for denial or ocatian of ray license t��dd forprosecutionunder IN.G.1.. Ch. 26R. Section 1. Appricant'sSignature: rvi�%iri!/� il�C//C,Q� a,y Date: .�(1i5 lC7 Owners Signature for atachmmtl Dar AppmrM By: Date: BtildingOfficial (or deign:) Zoning Distric tratorital Disrricr No Flood Plain Zone: Yes Water Resource Protection District: Within 100 ft. of Well Yes 7jle-- Yes "I Jun 14 10 01:38p Lynn McIntyre 5OM85-9407 p.3 . w: v�rcmo 3cs�n r10.� Dal 06Ji]9/�qlU 1D:Afi 5D852B691q BEW( INS FRAm{LT1r PAAI 11ar09 CERTIFICATE OF LIABILITY INSURANCE � °YOOgCE/ ,po ' C11►6e-3 1 . A 1[+ ull1G Qarty ZaAEiretaep l�gstlCy NIfORM1. Y/AfOCOtuCEg6H,R10NTBlA�oyTHlC�rSll/l.n*L 9 X11131 Serest 7EHrJ PW CERTWMATE OOaa N01 ANUIIDi4TF.=TaDk1Ln MA 02o!ii RTHECOVi±g AF;OADi GvTocPCLIQA:SCil Fasllene-Ss0-i911 L1lb AFFOfi011tG G9YFitACB I lU G ✓f - !xt'JaiR �• Coe Insurance Ca -_ -. ••-�• Ciid9t ,Is C 7PY ce�lany, iLc I wer�AA a to I Tln A unite set. 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OiL6D®DRQ1C'L as/zl/1O as/21/u �oat+alc��ar t 1.0:70 OCp 1 tpt601l1IDAl1105 I X TSAEDAli 1C Na1-0VMECAutos ' 1 Pa�iabxP+l ._..,.r -- rROKN1T Oarglg oARAci uAsluiT �I =IOU: .. 1 t ANfuno I ,�,..._,__•_ AUTor-t+ceeeewT t i I 91ReN twN 95ACC a 22mm'"I'll w u.PUTr All Oil —• �oceuR CCIaJMCAIroe eAeaaeamlBre + —= e I "malt Tn _ ►Eanyor�nICkVeEDr0gdr2►uT NAA! lyTMV i.`I.�. ln°`� i/1Oc�5a9�E23 01/im,i/o1/11 .:TAI*s.. l_OG,OC-yO�'• ASfCrC. I w IdEt l4: ►RwIGICMr xPa i k1X1l4fDEAT yp_Pqp.• T -16META7 E0, 000 _ EL 07'Asr • PotrevLO41111ii 500 0 0 0 G 84Ll:Dnl= PlOates CROD33096( r CS/O=/10I O5/O1 11 1 Saoo,aoa rsma ATPTTQ1a,t iDt4 ►QGAT1pbTVPtP.�CS! 1U09D Eco09s >�ron! of CW494ge/OrGerg 10326/9et FNj�iPCO�ILPtOystAO 2 900 T be• yt� '. Gf15%30 up 6/11/in, ETranp C/13/30 E =sxe ;klttea I I • CGRT1i1GAT1! NOLClR J _ CArICE1LLA 110N —"-"� aYCtllO AYT OP TWSAPeYt QttrRIM7fOC7CKt 0[u1NCL•iVS . TAYLCR>• F �••l:�-t Tee TTNtATILn gATETxIRipi.Tt@IttuAgwUAtaN.ly tlaFvtrt70 l[A4-... un9trA1TTLY _ Jill TOT"ate 1fi dilCIA"MTo7WC►rJJnUTfT4I.o.,i C==14A1t 1 TP.a 1011or PrCIIarvi icsi Anne,,. T p near warm 1iomi tWtt R7 DALliAT1CA1 DA W Pil1TT DCAhT RDIp YPCM TN7 i�mntF� ITi A@:M711 Cq . RDA bli Ofars 22" crt 021 ACOiID 71 (TAOQ/01) -- - Re ACORO rams &W IDpD Aro n :Fend rnArts el ACCIIQ 0 amil PA.. .. - IMPORTANT DOCUMENT � rtr#ixa �e of flaw 3atoioxauce ISSUED 13Y FEGISTEFMD Ihb of Mardula&--m qpP NN :ma 1D103�0 NUIUQiIEMLfi �"••'"•�"�"` EVRMWU.E. INIX" 47711 wader tturrWer F1�.7 3t01G0 MANUFACTURERSDFTHE F1h iM Te4rrnoDUCrBUESCR8ED HEREIN Thls is to cerdry that the materials described have been. flame-retardant treated (or am inhersntty.noninRsmmabte) and were suppled toe %CS/viravM --4'1 Zfi0M CHASE CANOPY COMPANY 4 NICKY'S 1ANF .POBOX4G MA37APOISErTE MA OZT390405 Certilicaiion is hereby made dab Tfia articles desermad on this CertlFicatle have been treated with a bane-rletardant approved chemical and that the application of said chemical was done in conlerwtanav, with California Fire Marshal Goder equal to exceeds Ti1FPA 701, CPAI 84. 111-10 109. The method of Rite F R chemical application is: bcrlat 7: eta100 RI DMrIPIM of Item osrt W. ®rr MW 40W x 20YL W V Fiame Retardant Process USM Will Not B0 tiemovea t3y Washing And Is Effective For The Life Of The Fabric soled: nwa..-D, z..s-2 d oLt5aral f-elLih TvirrepAmmEmr— ction RgER IND. IMPORTANT DOCUMENT Cerif icate of 1plai w Resista"= ISSUED OV nate ul Mendadure REMSM,T1oN APP11CAM011 tttss►at NUM9Ett iw' EVANSVILlE, -IMDIANA 47725 Order Number MANUFACTURERS OFTHE FINISHED ss?19t Fll41 TENT PRODUCTS DESCRIBED HEREIN 'ihfs is to earthy that the notarial" described have been flame-retardant treated (or are inherently nonirrflarnmabte) and were supplied lot 260" CHASE CANOPY COMPANY 4 MCI= LN P o SOX 4B NATTAPOISETTE MA 027390405 eeriiflcatlon ie hereby made that' The articles described on this taertlficato have beets treated with.a 112me-retardant approved chemical and that the application of said rbemlcal was done In conformance with California Fire Marshal Code, equal to exceeds NFPA 701, CPAI 04, ULC 109. The method of the FR chemical applicalloD Is: �fatll • tisimoPl V0=r#W0n of item mwta0a0WX.40laWMMWa Flame Relmilant Process Used Will Not Be Removed By Wasting And Is Effective FotThe Life Of7he Fabric ANCNoa (NOOMIES 7/172015 SlipGen -Portal Home Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg33451] Document Category Building Permits Map -Block Number 151.24.1 Street Number 0108 Street Name BRAY FARM RD NORTH Department Building Parcel ID 17481 Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time No Operator, Yarmscan 2015-07-17 - 08:55 tttp1Aaserfiche12/91pGer1 1!1